e
r
m
e
n
t
c
o
m
b
i
n
e
d
w
i
t
h
t
h
e
c
l
i
n
i
c
a
l
e
x
p
e
r
i
e
n
c
e
o
n
f
i
n
a
l
y
e
a
r
n
u
r
s
i
n
g
s
t
u
d
e
n
t
s
.
In the Lourdes Hospital Enquiry into peri-partum hysterectomies of young
mothers, Judge Clark noted the midwives response was that their ‘training did
not facilitate questioning’. Others simply wept and said that they had ‘not got
the confidence to question’ (p.316). Judge Clark noted “obedience was part
and parcel of the training of nurses” (Government of Ireland, 2006 p. 187).

Nursing has evolved from being perceived as being “handmaidens
to the doctors” to that of health professionals (Jinks & Bradley,
2003). What is the relevance of this cultural context?

Historical legacy emerged as a key theme in an Irish national
study of registered nurses views on empowerment (DOH & DCU,
2003).

As Ireland is leading the way in nurse education with degree only
entry in place for last ten years it is timely that the nursing
students of today are the focus of a study to explore their views on
the empowering /disempowering factors at play in the clinical
learning environment
Elusive, difficult to define and complex concept can
fluctuate and change (Bradbury- Jones et al. 2010)
 Keiffer (1984) suggests it is easier to define in its
absence.
 Rappaport (1984) suggests it is like obscenity we
might not know what it is but we know when we see
it.
 Working definition for the study is that empowerment
is viewed as a desirable and positive concept that
incorporates energy and impetus to do good for ones’
self and others within a nursing context.


Bradbury Jones et al. (2007) suggests that nursing students can be empowered or
disempowered depending on context. In this study critical incidents were
provided by 66 nursing students relating to incidents of empowerment
/disempowerment.

Bradbury Jones et al. (2010) in a longitudinal phenomenological study found that
students were both empowered and disempowered in clinical practice.

In Bradbury- Jones et al. (2010) phenomenological study of third year nursing
students found that empowerment of students is multifaceted and involves the
following
-Knowledge and Confidence
-Being Valued
-Mentorship and Placements
-Cultural and Structural Influences
Nursing students used strategies to promote their own empowerment (Bradbury
Jones et al., 2010). The study did not describe what the “strategies” were.
PROMOTIONAL BEHAVIOURS
PREVENTING BEHAVIOUR
-Moral Principles
-Personal Integrity
-Expertise/Competence
-Future Orientation
-Sociability
-Conflicting Values
-Distrust
-Resistance to innovation
-Lack of information
-Hierarchy
-Short working periods
-Lack of openness
-Nullification
Kuokkanen & Leiono-Kilpi (2000)

Laschinger measured organisational empowerment in
several studies in Canada using Conditions for Work
Empowerment Questionnaire (CWEQ-11)

Spreitzers’ (1995) questionnaire measures psychological
empowerment Psychological Empowerment Scale (PES).

Ibrahim (2011) found nursing students moderately
empowered in a study that used Spreitzers’ PES in a study
of nursing students’ level of self esteem.

Corbally et al. (2007) noted that all measurement of
empowerment found that registered nurses were
moderately empowered
CONSTRUCTS
Structural Empowerment
(Access to Opportunity, Support,
Information and Resources )
Psychological Empowerment
(Meaning, Competence, Self-
determination and Impact).
Critical Social Theory
Empowerment
(Being listened to, Being recognised as
professional by Multidisciplinary
teams, Being Involved in decision
making process)
MEASURES
Structural Empowerment is
measured using Conditions for
Work Empowerment
Questionnaire (CWEQ-11)
(Laschinger et al., 2010)
Psychological Empowerment is
measured using Psychological
Empowerment Scale. PES
(Spreitzer, 1995).
Critical Social Theory
Questionnaire (Casey et al., 2010)
This study will use Adaptive theory which is based
upon a critical realist ontology and epistemology as a
theoretical framework to explore empowerment.
 Adaptive theory is applied within a social realist
ontology namely Layders’ Social Domains Theory
(social ontology informed by realism).
 This theory acknowledges the macro (organisational
and institutional) and the micro (individual) factors
that impact our social reality (Layder, 2006).
 Casey et al. (2010) Irish study of 306 nurses supports
the importance of macro and micro factors in her
study of empowerment and job satisfaction in Ireland.

• Objective
Social World
Domains
• Subjective
Domains
Contextual
Resources
PsychoBiograrphy
Domain
Social
Setting
Domains
Situated
Activity
Domain

This study's’ framework will acknowledge the complexities
of the students’ social world in clinical practice and their
perception of that world in relation to empowerment.

Adaptive theory facilitates the use of existing theoretical
frameworks and acknowledges possibility of generating
new knowledge that will help in understanding this
complex phenomenon.




Focus Groups will provide an opportunity for the
students to discuss and agree/disagree on what
empowers/disempowers them
Data from this study will contribute to how
educationalists and preceptors view clinical
placements in nursing programmes.
This study will augment literature from previous
studies on nursing empowerment (BradburyJones et al. 2008; 2009).
It is envisaged that this study will contribute to
the development of future policy on nursing
education.
Bradbury-Jones, C. Sambrook, S. Irvine, F. (2007) The meaning of empowerment for nursing
students: a critical incident study. Journal of Advanced Nursing 59(4), pp. 342-351.
Bradbury-Jones, C., Irvine, F., Sambrook, S. (2010) Empowerment of Nursing students in clinical
practice: spheres of influence. Journal of Advanced Nursing 66(9), pp. 20661-2070.
Casey, M., Saunders, J. & O’ Hara, T. (2010). "Impact of critical social empowerment on psychological
empowerment and job satisfaction in nursing and midwifery settings." Journal of Nursing Management 18 (1),
24-34.
Department of Health and Children/Dublin City University (2003) Nurses’ and Midwives’
Understanding and Experiences of Empowerment in Ireland. Final Report. Stationary Office,
Dublin.
Government of Ireland (2006) The Lourdes Hospital Enquiry: An Inquiry into the Peripartum
Hysterectomy at Our Lady of Lourdes Hospital, Drogheda. Stationary Office, Dublin.
Ibrahim, S. (2011) Factors affecting assertiveness among student nurses. Nurse Education Today,
31(4), pp. 356-360.
Jinks, A.M. & Bradley, E. (2003) Angel, handmaiden, battleaxe, or whore? A study which
examines changes in newly recruited student nurses’ attitudes to gender and nursing
stereotypes. Nurse Education Today 24, pp. 121-127.
Kanter, R. M. (1997) Men and Women of the Corporation. Basic Books, New York, NY.
Keiffer, C. (1984) Citizen empowerment: a development perspective. Prevention in Human Services 3, pp. 9-36.
Laschinger, S., Gilbert, S., Smith, L., Leslie, L. (2010) Towards a comprehensive theory of nurse/patient empowerment:
applying Kanter’s theory to patient care. Journal of Nursing Management 18 (1), 4-13.
Layder, D. (2006) Understanding Social Theory. 2nd ed. Sage Publications, London.
Rapport, J. (1984) Studies in empowerment: introduction to the issue. Prevention in Human Services 3, pp. 1-7.
Spreitzer, G. M.(1995). “Psychological empowerment in the workplace: Dimensions, measurement, and validation”.
Academy of Management Journal 38 (5), 1442-1465.