The title accurately describes the study, identifying the topic of the inquiry and the selected methodology. The abstract is fairly representative of the study: the method, sampling details, and data collection method are presented, and the findings are considerably detailed, including the reasons behind some of the results. At the same time, the authors’ motivation and the relevance of the paper are not mentioned in the abstract at all.
The introduction focuses on the general information about empowerment and shared governance, giving the reasons for the shift from the traditional hierarchical model and asserting the benefits. The authors outline the positive outcomes of the empowerment both from the organization’s perspective and the patient’s point of view. The previous related research by the same authors is also detailed.
There is, however, no visible problem statement, which suggests that the study is aiming at complementing the available body of knowledge and increase the understanding of the phenomenon rather than addressing a certain issue. The reason for conducting research is thus somewhat vague, being partially grounded in the recent tendency of shifting towards a shared governance model but not being conclusively detailed except for the generalized statement of the problem being insufficiently researched.
As the study is qualitative, there is no research hypothesis. At the same time, the research question, “to investigate staff nurses’ perception and experiences about structural empowerment and perceptions regarding the extent to which structural empowerment supports safe quality patient care” (Van Bogaert et al., 2016), is noticeably vague. Besides, its second part is questionable, as it is aimed at exploring the nurses’ perception of the likelihood of the positive outcome, while the outcome itself is a long-established and thoroughly researched fact (Gulzar et al., 2015; Gunnarsdóttir, Clarke, Rafferty, & Nutbeam, 2009; Schubert, Clarke, Glass, Schaffert-Witvliet, & De Geest, 2009).
In the qualitative research based on the limited number of interviews, a well-defined research question is highly recommended to direct the analysis. The paper does not mention a theoretical framework, which, while not encouraged, is not entirely unacceptable in qualitative research, given its generalized topic (Boeije, 2009). The separate literature review section is also absent from the paper, but the references to relevant sources are present in the introduction section. The majority of the cited literature sources are reputable and up-to-date but are noticeably broader than required for the scope of the study. While this is consistent with the generalized nature of the inquiry, it further compromises the clarity of the research.
The study is based on the phenomenological method within a constructivist paradigm (Van Bogaert et al., 2016). The sample consists of 11 nurses working in five different units of a single Belgian university hospital undergoing the governance transformation. The sample was small and not randomized but representative of the target group, so it fit the research design. The data was collected via semi-structured interviews approved by the ethics committee of the Antwerp University Hospital Belgium (Van Bogaert et al., 2016), so all the practices were ethical.
The reliability and validity of the data were strengthened by the performed audio recording. Additionally, two researchers coded one of the interviews independently, decreasing the possible introduction of bias. There is no mention of tools used for data collection. The analysis was conducted via a thematic approach: the data was reviewed and coded, and common themes were determined and described. The thematic analysis was performed using the NVivo 10 (QRS International) software tool (Van Bogaert et al., 2016). No obvious inconsistencies were noticed with the research design and question.
The findings are mostly presented in the form of the set of prevailing themes and their interconnections. The results are described thoroughly in text format, including a detailed interpretation of each theme and excerpts from nurses’ responses. There are no tables or graphs related to the findings except for the demographic characteristics of the sample. The results correlate to the research question and demonstrate the significance to nursing.
While the study mostly recounted the positive and negative perceptions of staff nurses regarding the transformation process, it also tackled such questions as familiarity with and awareness of the concept and the negative outcomes of the empowerment process. The latter is especially valuable as this side of the question is rarely considered by the researchers (Van Bogaert et al., 2016).
The study had several obvious limitations. First, the small sample size, lack of randomization, and the use of snowballing for sampling introduced the possibility of bias into the process. Second, the perception was assessed through personal testimonies, which is not a reliable source and often distorts the actual state of events. Finally, the data was collected in the process of transformation, eliminating the possibility of hindsight. The level of evidence is thus IIB (Shekelle, Woolf, Eccles, & Grimshaw, 1999).
In conclusion, while the study lacks defined direction and supports the previous findings rather than introduces new ones, it can be utilized in nursing practices. The findings regarding possible negative outcomes may serve to prevent complications in facilities undergoing the transformation. However, keeping in mind the limitations of the research, the additional inquiry is recommended. Besides, the development of guidelines for avoiding complications is desirable before the study results are recommended for use in nursing practice.
Boeije, H. R. (2009). Analysis in qualitative research. Los Angeles, CA: Sage.
Gulzar, S., Karmaliani, R., Vertejee, S., Khan, K. S., Amarsi, Y., & Macfarlane, J. (2015). A qualitative study of nursing leader’s perceptions of professional empowerment amongst pakistani nurses. International Journal of Nursing Education, 7(3), 247-251.
Gunnarsdottir, S., Clarke, S. P., Rafferty, A. M., & Nutbeam, D. (2009). Front-line management, staffing and nurse–doctor relationships as predictors of nurse and patient outcomes. A survey of Icelandic hospital nurses. International Journal of Nursing Studies, 46(7), 920-927.
Shekelle, P. G., Woolf, S. H., Eccles, M., & Grimshaw, J. (1999). Clinical guidelines: developing guidelines. British Medical Journal, 318(7183), 593-596.
Schubert, M., Clarke, S. P., Glass, T. R., Schaffert-Witvliet, B., & De Geest, S. (2009). Identifying thresholds for relationships between impacts of rationing of nursing care and nurse-and patient-reported outcomes in Swiss hospitals: a correlational study. International Journal of Nursing Studies, 46(7), 884-893.
Van Bogaert, P., Peremans, L., Diltour, N., Dilles, T., Van Rompaey, B., & Havens, D. S. (2016). Staff nurses’ perceptions and experiences about structural empowerment: a qualitative phenomenological study. PLoS One, 11(4).