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Copyright by Yi Liu 2008 Copyright by Yi Liu 2008 The Dissertation Committee for Yi Liu Certifies that this is the approved version of the following dissertation: Taiwanese Nurses’ Empowerment and Participation in Decision Making Committee: Eun-Ok Im, Supervisor Tracie Harrison Alexandra Garcia Adama Brown Wonshik Chee Taiwanese Nurses’ Empowerment and Participation in Decision Making by Yi Liu, B.S.; M.S. Dissertation Presented to the Faculty of the Graduate School of The University of Texas at Austin in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy The University of Texas at Austin May 2008 Dedication To the Lord To my parents To my brother To my friends in ACCCF Acknowledgements First of all, I would like to give thanks to the Lord. He has granted me strength and wisdom to go through all the difficult times in my doctoral study. My thanks also go to the participants in this study. Their participation has made this study meaningful. My greatest gratitude goes to the Chair of my dissertation committee, Dr. Eun-Ok Im, for her support and guidance in my theoretical thoughts, feminist insights, nursing outlook and personal development over the past five years. Her mentorship has provided me the opportunity and experience to become a better researcher. I want to thank her for her patience, advice, generosity, openness and encouragement. I would like to give thanks to each of my dissertation committee members for their instructions. Dr. Tracie Harrison helped me to think more thoroughly regarding my qualitative research questions, data analysis and the presentation of qualitative findings. I am grateful to Dr. Alexandra Garcia for her warmness and supportive advice. I want to thank Dr. Adama Brown for her support on statistical analysis and data interpretation. I am grateful to Dr. Wonshik Chee for his support on the Internet study. Without his help, this study cannot be completed. I thank my fellowship friends in the Austin Chinese Christian Campus Fellowship (ACCCF) for their brotherly/sisterly love, kindness, emotional support, and prayer. They are like my family in Austin. I would like to give my family, my dearest mother and brother, my deepest gratitude for their love, support and encouragement. They helped me go through the most difficult time when my father passed away during my second year in the doctoral study. It is because of their love and support that I can finish my doctoral education. v Taiwanese Nurses’ Empowerment and Participation in Decision Making Publication No._____________ Yi Liu, PhD The University of Texas at Austin, 2008 Supervisor: Eun-Ok Im The purposes of this cross-sectional and internet mixed methods study were: (a) to explore the level of structural empowerment (SEP), psychological empowerment (PE), participation in decision making (PDM), their relationships, and their predictors among Taiwanese nurses, and (b) to explore the influence of contextual factors (culture and gender) on the nurses’ perception on their work environment and PDM based on the feminist perspective and Laschinger’s expanded empowerment model. This study included an Internet questionnaire survey (quantitative) and a Web-based online forum (qualitative). A convenient sample of 163 Taiwanese registered nurses (a) who are currently working full time in health care institutions for at least 3 months, (b) can read and write Chinese on the computer, and (c) have access to the Internet was recruited and completed the internet survey. Among them, 20 completed the online forum discussion topics. vi The findings of the internet survey indicated that participants had moderate level of SEP, high-moderate level of PE and low level of PDM. Personal characteristics, such as age, education, and work experience, did not significantly correlate to Taiwanese nurses’ empowerment. However, the work structures, such as workload, types of hospitals, and work units, were significantly related to Taiwanese nurses’ empowerment and PDM. PE was a mediator between SEP and PDM, which indicated that with increased access to workplace empowerment structures, nurses perceived better personal empowerment, which in turn increased nurses’ PDM. In the online forum, two themes were discovered: (a) foot-binding unto nursing and (b) not open up. The first theme indicated that certain stereotypes regarding gender roles in Taiwanese society were restraints to the growth of nursing. Due to the stereotypes, nurses were located in the lower social status and developed powerless behaviors. The second theme indicated that communication among nurses was not sufficient, which might stem from the influence of Confucianism, collectivism, and power distance. The findings in this study extend our understanding of the empowerment and PDM among Taiwanese nurses within the context of gender and culture. vii Table of Contents List of Tables ........................................................................................................ xi List of Figures...................................................................................................... xii Chapter 1: Introduction .................................................................................... 1 Background .................................................................................................. 2 Purpose.......................................................................................................... 5 Specific Aims and Research Questions ...................................................... 5 Significance................................................................................................... 6 Definitions of Major Concepts.................................................................... 9 Assumptions................................................................................................ 10 Summary..................................................................................................... 12 Chapter 2: Theoretical Background and Review of Literature .................. 14 Theoretical Background............................................................................ 14 Feminism in General......................................................................... 14 Feminism and Nurses’ Empowerment............................................ 16 Taiwanese Nurses’ Empowerment from a Feminist Perspective . 17 Laschinger’s Empowerment Model ................................................ 24 Structural Empowerment (SEP) .............................................................. 28 Psychological Empowerment (PE) ........................................................... 34 Participation in Decision Making (PDM) ................................................ 39 Conceptual Framework............................................................................. 48 Summary..................................................................................................... 49 Chapter 3: Methodology..................................................................................... 51 Feminism and Mixed Methods ................................................................. 51 Mixed Methods........................................................................................... 52 Internet Methods........................................................................................ 55 Research Design ......................................................................................... 62 Study Setting............................................................................................... 63 viii Research Participants................................................................................ 63 Inclusion Criteria.............................................................................. 63 Sample Size........................................................................................ 63 Instrumentation.......................................................................................... 64 Psychological Empowerment Instrument (PEI) ............................ 64 Nurse Work Empowerment Scale (NWES).................................... 66 Decisional Involvement Scale (DIS) ................................................ 67 Procedures for Data Collection................................................................. 68 Protection of Human Rights ..................................................................... 70 Informed Consent ............................................................................. 70 Protection of Confidentiality............................................................ 71 Data Analysis.............................................................................................. 71 Quantitative Internet Survey Data.................................................. 71 Qualitative Online Forum Data....................................................... 74 Rigor of the Study ...................................................................................... 74 Pilot Study................................................................................................... 77 Summary..................................................................................................... 85 Chapter 4: Results of Internet Quantitative Survey........................................ 86 Demographic Characteristics of the Sample ........................................... 86 Assumption Check ..................................................................................... 88 Research Question
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