PROJECTIVE TECHNIQUE ACTIVITY: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.

22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. What I like most about nursing is _______. Nursing is not mainly caring. I am proud that I am a nurse when I see my fellow nurses disciplined. A nurse should never yes all the time. Nursing is life. What I hate most about nursing is not true caring. My most satisfying experience in my practice of nursing was to save life & disciplining my students and patients. I wish that nursing powerful. The one thing that a nurse should never allow others to do to her is put them down. A nurse is not basta basta. The most important characteristic of a nurse is authority. Nurses cannot postpone things/delay life. If I could change one thing about nurses, it would be their inability to work with authority. When I hear the word nurse, the image that comes to my mind is authority/power. If there is one thing that a nurse should never do, it is to reject a person in need. A nurse is respected. My most negative experience in my practice of nursing was parang tanga. Nurses need to fight for principles in life. Nurses today are powerless/decrease discipline. Giving nursing care is not only job/relatedness. As a nurse, i want to be able to radiate authority to fellow nurses. A nurse should not be put aside. Nurses are becoming easy go lucky without life. A nurses weakness lies in his/her power to decide. What I admire about nurses is that they are loving and soft hearted. For someone to succeed in nursing, he/she should be knowledgeable to be powerful. If I were a patient, I would want my nurse to be in authority to control my life. I am ashamed that I am a nurse when I see my fellow nurses keep on following orders without thinking. If there is one thing that nurses need, it is power of knowledge and decision making. A nurse should never boastful at wrong time. Giving nursing care is my basic responsibility. If I were a patient, I would not want my nurse to be powerless in deciding. What I detest about nurses is that they are just following?. A nurses strength lies in his/her heart and mind. Nurses do not think of evidence based practice. Nurses can be powerful with evidence based practice. The best nurse is someone who can control the heart. EQ + IQ. Nurses should stop being pa cute lang/plastic. Nursing has become . . . deteriorating. The worst nurse is someone who follows without evidence base or justification.

CONCEPT ANALYSIS: NURSE EMPOWERMENT DEFINITIONS Merriam-Websters Dictionary (2012), empowerment means to give official authority or legal power or to promote the self-actualization or influence. According to Wikipedia, Empowerment refers to increasing the spiritual, political, SOCIAL, educational, gender, or economic strength of individuals and communities. Sociological empowerment often addresses members of groups that social discrimination processes have excluded from decision-making processes. According to author Stewart, in her book Empowering People she describes that empowerment is simply the effective use of a managers authority, and subsequently, it is a productive way to maximize all-around work efficiency. Empowerment is the ability to get a job done well with the necessary information and equipment to accomplish the work

LITERATURE REVIEW Kanter argues that social structures within the work environment that provide employees with access to information, support, resources, strong interpersonal relationships, and opportunities to learn and grow are empowering and allow employees to accomplish their work in meaningful ways. A literature review conducted by Lee and Cummings found that organizational support within the institution was a significant contributing factor in empowerment. Lee and Cummings used Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed to conduct a literature review, searching on the following phrases: staff nurse empowerment, and nurse engagement and job satisfaction. This is consistent with the organizational theory described by Kanter, an expert in the field of organizational behavior. The literature revealed extensive research on empowerment and its importance as experienced by employees. Change is, of course, a constant in health care, and sustainability is a major area of importance. Therefore, researchers have worked to better understand the ways in which different groups of workers perceive empowerment from a multidisciplinary perspective. Currently, the full range of the consequences of empowerment in the nursing profession is not fully understood. However, findings from the Institute of Medicine reveal that a likely value of the empowerment of nurses is the promotion of safe patient care and improved patient outcomes. Laschinger et al, have conducted extensive research on the empowerment of nursing staff and on leadership's ability to instill empowerment. Laschinger et al, conducted in an acute-care setting, demonstrated that effective leadership is a source of empowerment for staff.

ANTECEDENTS A study of nurses found that job satisfaction and reduced job stress can be two of the positive consequences of promoting nurse empowerment and can serve to reduce nurse burnout. Enhancing hospital nurses' experience of empowerment may stem the growing shortage of experienced nurses. A workforce is more likely sustainable when staff nurses trust and respect their direct managers. Unhealthy work environments, where nurses are emotionally drained and feel overwhelmed are more likely to be settings that risk patient safety. Nurses who feel empowered in their role express confidence and nurses who can empower their staff serve an important role in creating a healthy and safe work environment.

DEFINING CHARACTERISTICS/ATTRIBUTES Within a nursing context, empowerment can be conceptualized as a composite of attributes that relate to the nurse. In a broad sense, empowerment is a process of helping people to assert control over the factors which affect their lives. This process encompasses both the individual responsibility in health care and the broader institutional, organizational or societal responsibilities in enabling people to assume responsibility for their own health.

CONSEQUENCES Empowerment as perceived by middle management is crucial for carrying out leadership duties and, in turn, empowering frontline staff. Nursing administration must understand the importance of an empowered middle management so that middle management can lead frontline staff effectively and facilitate the delivery of safe, high-quality patient care. It is reasonable to speculate that when nurses perceive their work environment to be empowering, they will feel more supported to practice in a professional manner and characterize their work environments in magnet-like terms. MODEL CASE A model case is constructed to illustrate the concept of the grieving process. This case, which includes all the defining attributes and no other attributes, is an absolute instance of the concept (Walker & Avant, 1999).

BORDERLINE CASE - Kanter conceptualizes power as the "ability to mobilize resources to get things done"11(p210) and uses the analogy of an electrical circuit to describe how productive power is achieved and maintained in the work setting. Power is "on" when employees have access to lines of information, support, resources, and opportunities to learn and grow. When these "lines" or sources of power are unavailable, power is off and effective work is impossible. These lines of power are sources of structural empowerment within the organization. - There was some support for Aiken's 1 claim that nurses who work in more specialized areas are more likely to experience positive working conditions based on their more homogeneous knowledge and experience. 2 Nurse practitioners' NWI-R scores were considerably higher than those of the staff nurses in the other samples. Acute care nurse practitioners are highly specialized in a particular field and thus enjoy greater autonomy and control over their work, as well as close relationships with physicians. - The health care professionals would invite the patient to participate in health care decisions, but subsequently neglect the input made by the patient. - Magnet hospital research has shown that nurses are attracted to hospital work environments that promote autonomy and control over the practice environment and that foster good nursephysician relationships. 1 Aiken argues that these environments facilitate professional nursing practice. Nurses in magnet hospitals have lower levels of burnout and greater job satisfaction than nurses in nonmagnet hospitals. 2-4 Furthermore, research has shown that hospitals with these characteristics have better patient outcomes, including lower mortality rates. 5,6 Other researchers also have demonstrated a link between nurse-physician collaboration and mortality in intensive care units. 7,8 Clearly, nursing administrators would be well advised to ensure that these attributes characterize their work environments.

CONTRARY CASE A contrary case is a clear example of what the concept is not (Walker and Avant, 1999).

RELATED CASE - Symmetrical Relationships: Three studies reveal the importance of relationships (14, 15, 16). Though found in different contexts, similarities are present and include a sense of connecting and belonging. A Canadian study on chronically ill elderly presents building trust and meaning as key in establishing relationships that could evolve into symmetry and eventually empowerment (14). In a UK study on HIV- positive individuals, relationships were built within a self-help group and a sense of pride arose amongst the participants as a consequence of being able to help each other by sharing experiences (15). Health professionals, thus, are not always a necessity, within the element of relationships, for empowerment to take place. A Swedish study on a rheumatology rehabilitation unit further proves this as participants, though guided by health professionals, when sharing experiences in their interactions with co-participants produced positive self-images and positive social interactions (16). Whether with or without health professionals, relationships can be seen as a framework by which to connect the experiences of patients with the illness they suffer from.

INVENTED CASE According to Walker and Avant (1999), an invented case is a case that uses the ideas of the concept but outside our own experience.

IMPLICATIONS FOR NURSING Access to resources and information and the skill to fulfill role expectations make it possible to achieve more and to pass on more to subordinates. Employees who believe that their manager can get things done are more likely than those who do not believe in their manager's abilities to come together as a high-functioning team. Theoretically, staff responds effectively to work environments in which they feel empowered. The organizational benefit is manifested in better staff attitudes and increased efficiency. Empowerment is possible when employees have access to information, support, resources, and the chance to discover and develop. Empowerment also has implications for the relationship between nurse and patient. Nurses wishing to empower clients must understand the complexity of this approach because failure to do so could result in the nurse not recognizing the need for an individual approach which takes into account patients differing circumstances. This could result in patients being overloaded with information, creating unnecessary anxiety, rather than the nurse using his/her skills to assess and address individual needs.

CONCLUSION Empowerment is important at most levels of health care delivery. Just as staff nurses do, nurse educators who feel engaged, effective and with valued experience empowerment allows them to be effective in staff development and to make decisions quickly on the job. Empowered nurse educators demonstrated greater flexibility in adapting to ongoing change. Similar characteristics were found among staff nurses who expressed a feeling of empowerment in their work. It is important that nurse be given the opportunity to work together in a team meeting, to sometimes make mistakes, and to routinely contribute to the management decisions made about their work.

- Visibility of nurse managers at all levels in the clinical setting is an important indicator of support and gives clinical nurses the opportunity to demonstrate their clinical expertise and to be recognized for their skills. It is crucial that all levels of nursing management are genuinely committed to a shared vision fostering empowered behavior in staff. References