Nursing Culture: Overcoming Barriers Essay

Pages: 19 (5230 words)  ·  Bibliography Sources: 30  ·  File: .docx  ·  Level: College Senior  ·  Topic: Business - Management

Companies that succeed in implementing and administering this organization-wide management tool have also succeeded in changing their organizational culture prior to its adoption (Moore et al., 2002). As a result, organizations must develop strategies that are appropriate to the change and take steps to address any perceived losses on the part of the stakeholders to ensure higher levels of receptivity to change (Moore et al., 2002).

Moreover, there is a great deal at stake in attempting organizational change beyond the immediate initiative. If corporate leaders consistently seek to effect change in their organizations and fail, they will become regarded as ineffectual and a loss of faith and loyalty to the organization can result (Moore et al., 2002). In this regard, Moore and his associates emphasize that, "If there has been an organizational history of change attempts that have not been entirely or clearly successful, cynicism -- a real loss of faith in the leaders of change -- can arise despite the best intentions of those responsible" (p. 54). Unfortunately, such reactions remains salient even if the current leadership team is not responsible for previous failed efforts, and the lingering perception of ineffectuality can adversely affect future change initiatives as well (Moore et al., 2002).

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In spite of its proven importance in promoting higher employee performance levels, though, there has been a relative dearth of timely and relevant studies concerning nursing culture. In this regard, Mendyka and Bloom (1999) emphasize that, "The concept of culture in nursing is not always clearly defined. Nursing seldom acknowledges any specific culturally based theoretical orientation... [and frequently stresses] the specifics of individual cultural components rather than their interrelationship" (p. 180). Irrespective of any precise definitional differences, though, it is clear that nursing culture can have a profound effect on clinicians and patients alike. For example, Mendyka and Bloom also note that, "Culture is instrumental in the creation of contextualized meaning for a person's experience of health and illness. Culture is the source of the meanings attributed to the care situation as experienced by nurse and patient" (1999, p. 180). The importance of understanding this somewhat-nebulous construct is also made clear by Mendyka and Bloom's assertion that, "An awareness of culture and further examination of the concept of embodiment promotes an appreciation for, rather than a minimization of, the meaning of illness or health experiences of others" (1999, p. 180).

Some of the studies conducted to date have either included nursing culture as only an ancillary aspect of the research or have otherwise failed to examine it in its more complete context as it applies to creating and sustaining barriers to change. For example, an analysis of nursing culture by Rizzo, Gilman and Mersmann (1994) evaluated nursing department staff in 13 units preparatory to changing the care delivery model that was in use. The unit's nursing culture was measured using the Nursing Unit Cultural Assessment instrument and performance was measured with respect to unit skill-mix, cost, worked hours per patient day, quality assurance, documentation of care planning and discharge, and the level of patient satisfaction. The results of this study, though, showed that the initiative was less directed at effecting changes in nursing culture and was more focused on cost savings and achieving a reduction in professional staff nursing levels (Rizzo et al., 1994).

More recently, though, a study by Shortell et al. (2000) examined nursing culture and heart surgery patient outcomes and found mixed results, with the level of supportive nursing culture improving certain outcomes (i.e., reduced length of stay, shorter post-operative intubation periods, and higher mental and physical functioning test scores), but not others (i.e., length of time in the operating suite). Likewise, a follow-up study by Shortell et al. (2001) evaluated the implementation of evidence-based care in U.S. healthcare organizations to determine the effects of healthcare organizational culture on adoption rates. This follow-up study identified a distinct relationship between economic pressures and incentives, but little or no apparent relationship with nursing culture per se (Shortell et al., 2001).

Finally, the results of a study by Zimmerman et al. (1993) found a somewhat tenuous relationship between nursing culture and patient outcomes. The study by Zimmerman and his colleagues (1993) was fairly ambitious in its scope and used a combination of interviews, field observations and archived data. Based on their analysis of this broad-based data, Zimmerman et al. determined that, in general, strongly patient-centered nursing cultures and nursing leadership were related to reduced lengths of stay in intensive care units, but they were unable to correlate these findings with risk-adjusted survival rates. Consequently, the need for further studies in this area is particularly acute, a gap that this study sought to help fill by using the research questions set forth below as a guide.

Research Questions

The proposed study will be guided by the following research questions:

a) Does nursing culture affect performance in measurable ways (i.e., medication error rates, patient satisfaction levels)? If so, what have been the results to date and what areas require further investigation?

b) How can nursing supervisors and administrators overcome barriers to change created by nursing culture?

c) How can nursing culture be used to facilitate the implementation and application of evidence-based care?

The Design -- Methods and Procedures

The study's research design will be qualitative, consisting of a mixed methodological approach using a review of the relevant and timely peer-reviewed and scholarly literature as well as a series of case studies concerning overcoming barriers to change created by nursing cultures. With respect to the qualitative design, Banyard and Miller (1998) point out that, "Qualitative research methods are ideally suited to putting a valuation of diversity into practice. The link between qualitative research and diversity can be seen when considering qualitative research as purely a set of tools or methods, and also when examining it as reflective of an alternative research paradigm" (p. 485).

This qualitative mixed methodology is also congruent with the guidance provided by a number of social researchers concerning the need to examine a topic of interest from more than one perspective (Fraenkel & Wallen, 2001). For instance, with respect to the first component of the research methodology, Gratton and Jones (2003) emphasize that a critical review of the relevant literature is an essential task in almost all types of contemporary research. According to Gratton and Jones, "A literature review is the background to the research, where it is important to demonstrate a clear understanding of the relevant theories and concepts, the results of past research into the area, the types of methodologies and research designs employed in such research, and areas where the literature is deficient" (p. 51).

The use of a literature review to identify existing gaps in the body of knowledge is also cited by Wood and Ellis (2003) who identified the following as important outcomes of a well-conducted review of the literature:

a) It helps describe a topic of interest and refine either research questions or directions in which to look;

b) It presents a clear description and evaluation of the theories and concepts that have informed research into the topic of interest;

c) It clarifies the relationship to previous research and highlights where new research may contribute by identifying research possibilities which have been overlooked so far in the literature;

d) It provides insights into the topic of interest that are both methodological and substantive;

e) It demonstrates powers of critical analysis by, for instance, exposing taken for granted assumptions underpinning previous research and identifying the possibilities of replacing them with alternative assumptions;

f) It justifies any new research through a coherent critique of what has gone before and demonstrates why new research is both timely and important.

With respect to the second component of the mixed methodology, qualitative researchers have a number of research designs available, including historical methodology, ethnography, phenomenology, hermeneutics, grounded theory, action research as well as the case study (Burton & Steane, 2004). With respect to the latter approach, Zikmund (2000) advises that the case study methodology is "an exploratory research technique that intensively investigates one or a few situations similar to the researcher's problem situation" (p. 722). Likewise, Neuman (2003) reports that, "In case study research, researchers examine, in-depth, many features of a few cases over a duration of time. In a case study, a researcher may intensively investigate one or two cases or compare a limited set of cases, focusing on several factors" (p. 33). In fact, one of the major strengths of the case study approach is that a given topic can be investigated in depth and with greater attention to details that might be of interest to the researcher (Leedy, 1997). As Feagin, Orum and Sjoberg (1991) point out, "The study of the single case or an array of several cases remains indispensable to the progress of the social sciences" (p. 1). Generally speaking, case studies are used for three primary purposes:

a) Where little or nothing is known about the phenomenon… [END OF PREVIEW] . . . READ MORE

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