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A Model for Empowerment of Nursing in Iran Mohsen Adib Hajbaghery*1 and Mahvash Salsali2

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A Model for Empowerment of Nursing in Iran Mohsen Adib Hajbaghery*1 and Mahvash Salsali2 BMC Health Services Research BioMed Central Research article Open Access A model for empowerment of nursing in Iran Mohsen Adib Hajbaghery*1 and Mahvash Salsali2 Address: 1Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran and 2Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran Email: Mohsen Adib Hajbaghery* - [email protected]; Mahvash Salsali - [email protected] * Corresponding author Published: 16 March 2005 Received: 16 October 2004 Accepted: 16 March 2005 BMC Health Services Research 2005, 5:24 doi:10.1186/1472-6963-5-24 This article is available from: http://www.biomedcentral.com/1472-6963/5/24 © 2005 Hajbaghery and Salsali; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: 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, 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. Methods: A 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. Results: Three 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. Conclusion: A 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. Background nursing care in general and specialty hospitals. Although Iran, a country of sixty eight million has a national health the population of nurses is approximately one hundred service which employs over 70,000 nursing personnel and twenty thousand, many are unemployed. Among the (including operating room technicians) who provide unemployed are those who choose not to work after Page 1 of 11 (page number not for citation purposes) BMC Health Services Research 2005, 5:24 http://www.biomedcentral.com/1472-6963/5/24 marriage. Consequently, Iran like other countries is faced nian Nursing Association (INA) was formed by a group of with a nursing shortage. The impact of this nursing short- Iranian nurses who were educated abroad and returned to age lead nurses to work more than their required shift of the country [2]. Next, in 1952, a nursing division was 192 hours per month; with potentially 150 hours of over- established in the Ministry of Health and this was the first time in some parts of the country. The role of nurses is time nursing was officially recognized by the government unclear, for although most of them are employed in hos- and became part of its structure. The first university pro- pitals, yet few or none are in the role of Public Health gram for obtaining a BSN began in October 1967 at Shiraz Nursing. Additionally, because the people of Iran have a University [2,3]. poor image of nursing, those who choose nursing as a profession do experience low self-esteem. The combina- The increasing demand for healthcare in Iran forced the tion of poor image and questions regarding quality of stakeholders of nursing education to develop new initia- patient care, one would find it hard to believe that these tives to meet the demand. As a result, in 1975 The Minis- nurses are graduates with a Baccalaureate Science in Nurs- try of Sciences approved the Associate Degree of nursing ing (BSN) from either a nursing school or medical science program (ADN). Thereafter, nursing education in Iran was university. on the move, there were ADN, and BSN programs with a Masters of Science in nursing (MSN) program gradually Historical perspective of nursing in Iran developing. Although nursing education was growing, the Historically, records of nursing in Iran before 1915 numbers of graduates were still inadequate to meet Iran's showed that nursing care was carried out by household demand for healthcare. For example, between 1915–1979 women or servants. Hospitalized patients were also cared a total of 8,546 nurses graduated to provide healthcare for by untrained personnel [1]. Because of this history, services for a 30 million population. Because fully quali- lack of basic education, low cultural status, and some reli- fied nurses remained few in numbers, the alternative was gious limitations for women, nursing as a profession/ to complement the nursing care in hospitals with auxil- career neither gained high standard nor recognition. How- iary nursing personnel. ever, 1915 is noted as the turning point for nursing in Iran. During that year the American Presbyterian Mission- In 1979 when the Islamic revolution took place, major ary Society (APMS) pioneered the training of a few nurses social and cultural changes occurred. These changes not in a small missionary hospital. Subsequently, in 1916 a only impacted the health care system, but nursing services three-year nursing school was established in Tabriz. After too. Previously, the majority of nurses were female and 1916 there was a gradual increase of nursing schools they were caring for both men and women. However, as a across the country leading to a growing demand for nurse result of the Islamic revolution, the government decided educators who were already scarce [2]. Because there was that nursing school admissions constitute 50 percent a lack of qualified nurse educators in Iran the World males, with the belief that men should care for men and Health Organization (WHO) was appointed to assist in that women must be separate from men while they engage these schools. The Iranian faculty shortage was further in social activities. supplemented with recruits from England and United States of America (USA). A two-year program of study was Despite all the positive changes, bridging the gap of the developed and the entry-level requirement for these nursing shortage continued to be a challenge, for new schools was a minimum of nine years of general educa- issues continued to emerge and there were no easy solu- tion [3]. This minimum requirement failed to attract a tions or "quick fixes". Some of the issues that emerged large number of prospective nursing students for nursing were, increased birth rate causing an increased popula- being predominantly female and in Iran women were pro- tion, and the start of the imposed war between Iraq and hibited to engage in any social activities that required Iran which only proliferated Iran's nursing shortage. Con- close contact with men. Avoiding close contact with men currently, the Iranian government decided to re-structure is almost impossible in nursing, for healthcare system is the Ministry of Health where it was re-named The Ministry not designed to be all male or female and therefore posed of Health and Medical Education. Under this ministry a threat for nursing schools and the recruitment of pro- new institutions of medical and nursing education were spective nursing students. established and some existing institutions expanded. As a result, after the revolution 11,274 nurses were trained in Following the Second World War, Iran began gaining the first decade, with an addition of 22,000 more nurses momentum for advancing nursing as a profession. The over the next 7 years [1-3]. Also, after the war, nurses' Princess Ashraf School of Nursing was established with aides and ADN nurses were trained too. While providing the appointment of nursing faculty from England and educating the different types of nursing personnel nar- offered a three-year program where the admission require- rowed the gap of the nursing shortage dilemma, it created ment was a high school diploma. Then, in 1943 The Ira- Page 2 of 11 (page number not for citation purposes) BMC Health Services Research 2005, 5:24 http://www.biomedcentral.com/1472-6963/5/24 role ambiguity and masked the criteria for "who is quali- this newly established organization could play a signifi- fied to practice nursing". cant role in the development and empowerment of nurses, much time is needed to establish themselves as a To bring clarity to "who is qualified to practice nursing" governing body for nurses and they certainly have a tough the Ministry of Health and nurse leaders collaborated and job to shape the future of nurses and nursing in Iran. Since wrote job descriptions for the different levels of nurses. empowerment is crucial to the role of nurses, a qualitative However, these job descriptions were not fully imple- study was conducted and aimed at designing a model for mented because of several obstacles such as, vague or to empowering nurses in Iran.
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