Background: Empowerment is one of the most effective techniques for improving productivity of employees and optimum use of their capacities and capabilities toward organizational goals. This systematic review and meta-analysis aimed to evaluate nurses’ psychological empowerment in Iran. Methods: The required data were collected using keywords which are Empowerment, Psychological Empowerment, Nurse, Iran and their Persian equivalents. The databases searched were as follows: PubMed, Scopus, Medlib, SID, Magiran, and Iranmedex. Comprehensive meta-analysis software was used to data analysis. Results: Six eligible studies were entered into the systematic review. The results of this study show the mean score of nurses’ psychological empowerment based on the random effect model was 3.6 (95% confidence interval: 3.41-3.64). In the dimension of psychological empowerment, the higher score was related to competence (3.96). The next dimensions were meaningfulness (3.83), impact (3.47), self-determination (3.33), and trust (2.98), respectively. Conclusions: Nurses’ psychological empowerment was in a moderate level. Nursing managers need to further promote this dimension in their planning.
Keywords: Iran, meta-analysis, nurse, psychological empowerment
|How to cite this article:
Royan S, Alikhani M, Mohseni M, Alirezaei S, Khosravizadeh O, Moosavi A. Nurses’ psychological empowerment in Iran: A systematic review and meta-analysis. Ann Trop Med Public Health 2017;10:1558-62
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Royan S, Alikhani M, Mohseni M, Alirezaei S, Khosravizadeh O, Moosavi A. Nurses’ psychological empowerment in Iran: A systematic review and meta-analysis. Ann Trop Med Public Health [serial online] 2017 [cited 2021 Apr 11];10:1558-62. Available from: https://www.atmph.org/text.asp?2017/10/6/1558/222669
A major factor associated with increased employee efficiency, particularly in those working in health systems, is empowerment. Empowerment is one of the most effective techniques for improving productivity of employees and optimum use of their capacities and capabilities toward organizational goals. Empowerment can be defined as empowering the employees. Approaches used for empowerment include the mechanistic and organic approaches. The mechanistic approach entails delegating authority to subordinates, whereas the organic approach includes empowering in terms of personal beliefs and feelings. The aspects of organic empowerment (i.e., psychological empowerment) are not specific administrative measures and reflect the employees’ perception of their role in the organization. Psychological empowerment is a complex cognitive theory, which has five main cognitive variables including impact, self-determination, competence, meaningfulness, and trust., According to Spreitzer, psychological empowerment refers to a set of psychological states, that is, how much employees believe in their role and influence in the organization, how they think about their job, as well as their confidence to succeed. Workforce is the main factor of production and service in organizations, and the most important element influencing their survival and success. In health-care organizations, nurses are the largest group of health-care professionals that provide direct and indirect care to patients and play a major role in the quality of services., In hospital administration, increased research and attention is necessary in this critical field considering the high cost of human resources. Given the importance of nursing profession, nursing managers can ensure psychological empowerment of nursing staff and achieve health-care quality through empowering and supporting behaviors and creating opportunities for growth and professional development. Empowering the nurses can lead to organizational commitment, learning opportunities, job satisfaction improvement, patient satisfaction, and productivity, participation in decision-making, high-quality care, and sense of independence, responsibility, and self-confidence. Increased organizational effectiveness and decreased job stress and depersonalization are also among the effects of this important factor. Regarding the ultimate goal of therapeutic interventions improvement, which is to improve quality, research shows that psychological empowerment in the field of health care is directly associated with the quality of care provided by nurses., Thus, this systematic review and meta-analysis aimed to evaluate nurses’ psychological empowerment in Iran.
This systematic review and meta-analysis were conducted in 2016 according to The Preferred Reporting Items for Systematic Reviews and Misanalyses statement.
The required data were collected using several keywords such as Empowerment, Psychological Empowerment, Nurse, Iran and their Persian equivalents. The databases searched were as follows: Scopus, PubMed, Medlib, Magiran, SID, and Iranmedex. The selected time interval was not considered for searching for articles. To identify and cover higher number of the published papers, a number of reliable scientific journals in this field were searched manually. After excluding articles that were poorly connected with the study objectives, the selected articles’ reference lists were also searched to increase the reliability of identification and review of the articles.
Inclusion and exclusion criteria
Inclusion criteria were – (1) Articles published in Farsi and English; (2) Research conducted in Iranian hospitals; (3) referring to the average psychological empowerment in nursing staff; and (4) Access to full-text articles. Exclusion criteria included papers presented at seminars and conferences, case reports, letters to the editor, and educational articles.
Assessment of study quality
Study quality independently evaluated by two reviewers on the basis of the “Strengthening the Reporting of Observational Studies in Epidemiology” checklist.
Two reviewers extracted the data using a standard data collection form. The following data were extracted from eligible articles: author (s), publication year, sample size, hospital, city, and dimension of psychological empowerment [Table 1].
|Table 1: Extraction table
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To estimate the mean score of psychological empowerment in nurses, computer software CMA: 2 (Comprehensive Meta-Analysis) (Englewood, NJ, USA) was employed. For reporting the results, forest plot was used. Mean score of psychological empowerment was calculated based on random effect model with 95% confidence interval (CI). Heterogeneity of the study’s results was assessed by the I2 (I2 ≥ 50% indicate heterogeneity). The funnel plot was used to assess publication bias, and the Microsoft Office Excel 2010 was used to draw graphs.
Of the 365 article in the initial review, 6 were entered the final analysis. The reviewed articles are specified in [Table 1]. Studies were conducted between 2012 and 2016 on a total of 1319 nurses. The majority of studies were conducted in Tehran. Six eligible studies were entered into the systematic review. The results of this study show the mean score of nurses’ psychological empowerment based on the random effect model was 3.6 (95% CI: 3.41-3.64). The highest and lowest mean was related to the study of Attari (3.70) and Fathi (3.20), respectively. In the dimension of psychological empowerment, the higher score was related to Competence (3.96). The next dimensions were meaningfulness (3.83), impact (3.47), self-determination (3.33), and trust (2.98), respectively. The process of search and selection of articles was shown in [Figure 1].
|Figure 1: Flow diagram for study selection
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As shown in [Figure 2], The total mean score of nurses’ psychological empowerment based on the random effect model was determined to be 3.6 (95% CI: 3.41 – 3.64), (P< 0. 001, I2= 90.9).
|Figure 2: The total mean score of nurses’ psychological empowerment
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Result of this funnel plot show there was possibility publication bias among studies [Figure 3]
|Figure 3: Funnel plot
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The results of this study show the mean score of nurses’ psychological empowerment was 3.6. Psychological empowerment had generally a moderate score (as shown in [Figure 4]). An important point was the relationship between this variables and job satisfaction of nurses. Greater feeling of internal capabilities and risk-taking power in employees increases the job satisfaction., On the other hand, if people do not have positive feelings about their jobs, they will consider the job boring and useless. Many studies have shown a positive correlation between organic and psychological empowerment variables and job satisfaction.,,,,, Some studies have also reported a significant relationship between psychological empowerment and affective commitment and organizational commitment, which is a factor affecting the employees’ attitude and motivation toward their job., In other words, attention to psychological empowerment and improving it can affect other variables that influence the service quality and ultimately lead to improvement of management criteria and increased patient satisfaction. In the dimension of psychological empowerment, the higher score was related to competence (3.96). The next dimensions were meaningfulness (3.83), impact (3.47), self-determination (3.33), and trust (2.98), respectively. The competence dimension score indicates a desirable score of nurses in this dimension. In other words, the nurses believe that they have the knowledge and skills needed to perform their tasks. The study by Shelton showed that, among the psychological empowerment components, the highest mean score corresponded to competency, whereas the lowest score belonged to impact and self-determination. The results also showed that competence effectively helps to perform the role and also affects job satisfaction. Acquiring health promotion skills and knowledge are factors affecting competence., Meaningfulness had also a suitable score. This means that the nursing staff pursues important and valuable job objectives and follows a path that is worth their time and effort. Meaningfulness refers to the relationship between job objectives and tasks and the individual’s ideas and standards. It also refers to value of the objectives or the job that are judged in relation to individual standards or ideals. The lowest score corresponded to trust. Trust is the feeling of being certain that you are equally treated. It means that people have confidence that authorities not only do not harm them but also treat them fairly. Considering the low trust scores among other dimensions, creating confidence and personal comfort in interactions between employees and between managers and nursing staff is of special importance. Nondiscrimination between other employees and nursing staff and within the nursing staff promotes confidence to the system and ultimately improves job satisfaction.
|Figure 4: The mean score of dimension of nurses’ psychological empowerment
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According to results, nurses’ psychological empowerment was in a moderate level. Therefore, nursing managers need to further promote this dimension in their planning. Given the importance of people in organizations and their role in organizational success, and since one way to ensure job satisfaction is employee empowerment, organizational goals can be achieved to a great extent through empowerment.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 4], [Figure 3]