Influence of Work Environment Conditions on the Ability of Critical Care Nurses to Provide

119 Pages·2017·0.9 MB·English

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Doctoral Dissertations Dissertations and Theses
November 2017
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Yolanda M. Torres
University of Massachusetts Amherst
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Torres, Yolanda M., "Influence of Work Environment Conditions on the Ability of Critical Care Nurses to
Provide Efficacious Nursing Care in Puerto Rico" (2017). Doctoral Dissertations. 1132.
https://doi.org/10.7275/10405189.0 https://scholarworks.umass.edu/dissertations_2/1132
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Influence of Work Environment Conditions on the Ability of Critical Care Nurses to
Provide Efficacious Nursing Care in Puerto Rico

A Dissertation Presented

by

YOLANDA M. TORRES

Submitted to the Graduate School of the
University of Massachusetts Amherst in partial fulfillment
of the requirements for the degree of

DOCTOR OF PHILOSOPHY

September 2017

Nursing
© Copyright by Yolanda M. Torres 2017
All Rights Reserved
Influence of Work Environment Conditions on the Ability of Critical Care Nurses to
Provide Efficacious Nursing Care in Puerto Rico

A Dissertation Presented

by

YOLANDA M. TORRES

Approved as to style and content by:

–––––––––––––––––––––––––––––––––––––––––––––––––
Genevieve E. Chandler, Chair

_________________________________________________
Elizabeth Henneman, Member

_________________________________________________
Luis A. Marentes, Member

__________________________________________
Stephen Cavanagh, Dean
College of Nursing
DEDICATION

I dedicate my dissertation work to my family and many friends. A special feeling of
gratitude to my parents: my father José J. Torres Seijo, who taught me to never give up,
and my mother Yolanda Vélez Marina, who taught me that even the toughest task can be
accomplished if it is done one step at a time. My sons Iván and Brian, who were always
by my side and are my strength and inspiration. I also dedicate this work to my cousin
Luis J. Zayas Seijo, who has inspired me to dream.
ACKNOWLEDGMENTS
Over the past 7 years, I have received support and encouragement from many
special individuals. Dr. Yadira Regueira has been a mentor, colleague, and friend. Her
guidance has made this journey possible. I would like to thank Dr. Christine King, who
had the vision and commitment to start it all. My colleague and friend Sherily Pereira,
who has walked with me every step of the way.
Dr. Genevieve Chandler has been an outstanding dissertation director. I would
like to thank her as well as Dr. Elizabeth Henneman and Dr. Luis A. Marentes, members
of my dissertation committee. I would also like to thank Dr. Rubén Vélez, whose sage
advice, insightful criticisms, and patient encouragement aided the writing of this
document in innumerable ways.
During data collection my very good friend Elvia Cardona supported me mightily.
Could not have done it without her. Thanks to Dr. Aurea Ayala for giving me the push to
get started. Finally, my utmost appreciation to my editor Elizabeth Earl Phillips, who
walked with me through the finish line.

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ABSTRACT
INFLUENCE OF WORK ENVIRONMENT CONDITIONS ON THE ABILITY OF
CRITICAL CARE NURSES TO PROVIDE EFFICACIOUS NURSING CARE IN
PUERTO RICO
SEPTEMBER 2017
YOLANDA M. TORRES, B.S., UNIVERSITY OF DAYTON
B.S.N., UNIVERSIDAD INTERAMERICANA
M.S.N., UNIVERSIDAD METROPOLITANA
Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST
Directed by: Professor Genevieve E. Chandler
The purpose of this study was to explore the conditions in the work environment that may
contribute to caring efficacy of critical care nurses in Puerto Rico. The study measured
nurses’ perceptions of the empowering structures in the work environment, and the
relationship to their perceived caring efficacy and explored the correlation between
sociodemographic factors of age, education, and experience of work empowerment
and/or caring efficacy. The Conditions for Work Effectiveness Questionnaire and Caring
Efficacy Scale were used to assess the association between the nurses’ work environment
conditions and caring efficacy. The instruments were translated to Spanish and adapted to
the Puerto Rican culture. Using convenience sampling, the instruments were paired and
administered to nurses from selected critical care units of hospitals in Puerto Rico.
Participation was voluntary. Findings support that there is no relationship between the
working conditions environment and caring efficacy. Supplemental findings, however,
support a significant positive correlation between relationships with patients and families
and caring efficacy.
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TABLE OF CONTENTS
Page

ACKNOWLEDGMENTS .................................................................................................. v
ABSTRACT ....................................................................................................................... vi
LIST OF TABLES .............................................................................................................. x
LIST OF FIGURES ........................................................................................................... xi

CHAPTER

1. CONDITIONS FOR WORK EFFECTIVENESS, CARE EFFICACY, AND THE
EMPOWERED NURSE ..................................................................................................... 1

Problem Statement .......................................................................................................... 3
Background ..................................................................................................................... 4

Significance to Nursing ............................................................................................... 8

Purpose ............................................................................................................................ 8

Hypotheses .................................................................................................................. 9

Summary ....................................................................................................................... 10
2. REVIEW OF LITERATURE ....................................................................................... 11

Puerto Rico .................................................................................................................... 11

Cultural Influence ...................................................................................................... 11
Nursing Work Environment Conditions in Puerto Rico ............................................ 12

Work Empowerment ..................................................................................................... 14
Caring Efficacy .............................................................................................................. 21
Critical Care Nurse Work Environment ........................................................................ 26
Conceptual Framework of the Study ............................................................................. 28
Conceptual and Operational Definitions of Terms ........................................................ 33
Summary ....................................................................................................................... 35
3. METHODS ................................................................................................................... 37

Research Design ............................................................................................................ 37

Setting and Sample .................................................................................................... 38
Instruments ................................................................................................................ 39
Procedures ................................................................................................................. 43
vii
Data Analysis ............................................................................................................. 45

Summary ....................................................................................................................... 46

4. RESULTS ..................................................................................................................... 47

Introduction ................................................................................................................... 47
Sample Characteristics and Sociodemographic Profile ................................................. 47

Instrumental Analyses ............................................................................................... 50

Sample's Descriptive Statistics of the Research Variables ............................................ 51
Research Hypotheses ..................................................................................................... 54

Hypotheses 1, 2, and 3 ............................................................................................... 54
Hypothesis 4 .............................................................................................................. 56
Hypothesis 5 .............................................................................................................. 57

Summary of Findings .................................................................................................... 59

5. DISCUSSION ............................................................................................................... 60

Introduction ................................................................................................................... 60

Strengths and Limitations .......................................................................................... 68

Conclusion ..................................................................................................................... 69

Implications ............................................................................................................... 71

Summary ....................................................................................................................... 72

APPENDICES

A. CONDITIONS FOR WORK EFFECTIVENESS QUESTIONNAIRE (ENGLISH
AND SPANISH VERSIONS) .......................................................................................... 73

B. CARING EFFICACY SCALE (ENGLISH AND SPANISH VERSIONS) ................ 81

C. SOCIODEMOGRAPHIC DATA SHEET ................................................................... 88

D. HOSPITAL AUTHORIZATION LETTERS .............................................................. 89

E. SURVEY CONSENT FORM (ENGLISH AND SPANISH VERSIONS) .................. 91

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F. DESCRIPTIVE STATISTICS OF WORK EMPOWERMENT: ACCESS TO
OPPORTUNITY AND INFORMATION ITEMS ........................................................... 93

G. DESCRIPTIVE STATISTICS OF WORK EMPOWERMENT: SUPPORT AND
RESOURCES ITEMS ...................................................................................................... 94

H. DESCRIPTIVE STATISTICS OF WORK EMPOWERMENT: WORK
RELATIONSHIPS WITH PEERS & COLLEAGUES AND PATIENTS & FAMILIES
ITEMS ............................................................................................................................... 95

I. DESCRIPTIVE STATISTICS OF WORK EMPOWERMENT: WORK
RELATIONSHIPS WITH MENTORS ITEMS ............................................................... 96

J. DESCRIPTIVE STATISTICS: POSITIVE STATEMENTS OF THE CARING
EFFICACY SCALE .......................................................................................................... 97

K. DESCRIPTIVE STATISTICS: NEGATIVE STATEMENTS OF THE CARING
EFFICACY SCALE .......................................................................................................... 98

BIBLIOGRAPHY ............................................................................................................. 99

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