Empower Assigment

NBNC 1204 CLINICAL PRACTICE 10 (PROFESSIONALISM AND ISSUES 2010
IN NURSING B )
BY SALMAH BT MD SHARIF
Nursing Professionalism / Professionalisation in Malaysia
2.1 - Introduction
“ The Lady with the Lamp,”which it is address to Florence

Nightingale, is the most influential nurse in the history of modern
nursing.The first training school for nurses at Thomas’s Hospital,
London (1860) was founded by “The Lady with Lamp”. According to
Florence Nightingale learning a unique body of knowledge was
required to those wishing to practice professional nursing.
Nurses provide a variety of services to their patients. In general,

they help to prevent injury and disease, promote healthy living, and
care for the sick. They provide direct care for their patients through
administering medications, and assisting with convalescence and
rehabilitation. Nurses help people improve and maintain health by
creating and managing care plans for their patients. Nurses can
either choose to specialize in an area or many are general nurses
that perform a variety of duties as needed for the physician. Areas
of specialty include surgical, neonatal, anesthetist, gynecological,
and many others. Nurses often advance to become department
heads and supervisors, managing over other nurses, setting
standards of patient care, and even composing the department's
budget..
2.21 - Nursing professionalism
Professionalism refers to the conducts, goals or qualities that

characterize or mark of a profession of a professional person.
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Profession usually develops codes of ethic that describe the

expected behavior that reflect professionalism among its member.
Professionalism in nursing are set of rules, work ethics, ideologies,

work principles and dedication towards the service of a community,
that holistically gives a class and identity to this profession. In truest
sense, professionalism in nursing is more of an attitude of the
nurses towards the nursing profession.(Schwirian 1998)
2.22 - Nursing Professionlisation
Professionalisation is a process through which an occupation goes

through as it moves to the profession end of the occupation
profession continuum.(Schwirian 1998)
During the twentieth century, the nursing profession has under

gone immense change. Nursing has progressed from an
occupation to a fully licensed profession, with members that provide
a broad range of services independently, and in a variety of
professional relationship with other providers. This evolution has
changed how nurses are educated, clinically prepared, and how
they perceive their role.
According to Colyer,(2004) These changes can be characterized as

the professionalization of health care work, and also as moving
away from the tradiotional National Health Service (NHS) role
culture (where job titles denoted what people did and their place in
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the hierarchy) towards greater role divertsity and a more

meritocratic system.
Becoming a professional involves unique training, formal education,

achieving credentials,activity in continuing education opportunities,
joining and actively involving in professional association.
2.3. Nursing issue in Higher Education
Nursing issue in Higher Education is identify relating in clinical

practice , which may effect nursing professionalism in Malaysia.
In this paper, I will try to highlight the need of higher education in

nursing profession. The changes in medical education have been
proposed earlier by Flexner report. The Report (also called
Carnegie Foundation Bulletin Number Four) called on American
medical schools to enact higher admission and graduation
standards, and to adhere strictly to the protocols of mainstream
science in their teaching and research. Flexner, Bixler’s & Bixler’s
and Kelly believed that practitioner needs to educate in Institution of
Higher Learning to become a peer profession. Perhaps no issue in
nursing has been more controversial than the education of its
practitioners. Nursing’s heritage, like that of medicine, was founded
in apprenticeship. Students were assigned to experienced
practitioners who taught the skills with which they were familiar.
Once those skills were acquired, the student moved into the world
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of employment. Earliest programs of education were located in

hospitals rather than colleges or universities.
2.4 Aim
To highlight the need of higher education in nursing profession.
2.5 Discussion
2.5.1 A Day In Nursing Life. Nurses work in many different

settings, including hospitals, clinics, nursing homes, schools,
corporations and even patient homes. Home health and public
health nurses travel more than other nurses, to patients' homes,
schools, and other sites. Nurses generally work eight hour shifts,
but some hospitals have nurses work ten and twelve hour shifts for
three or four days a week. Nurses in hospitals, and nursing and
residential homes tend to work weekends, nights, and even
holidays, and are often on-call. Nurses are on their feet a lot at
work and therefore must be in relatively good physical shape. They
must also have good communication skills in order to deal
effectively with patients by practicing good listening and giving clear
directions to both patients and aides. A positive disposition and
mental strength is essential to this position as it can be stressful
and emotionally challenging to deal with human suffering and
emergency situations on a day-to-day basis. A nurse should have a
caring and sensitive nature in order to best care for patients.
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2.5.2 Education and training.
Over time, the settings in which nurses are educated have

changed. Today, most nursing programs preparing Registered
Nurses are located in institutions of higher education or
collegiate settings. But, not all nurses today are educated in
colleges and universities. There are four main educational
programs available for nursing. To become a licensed practical
nurse you must complete a state-approved practical nursing
program, which are usually offered through community and
technical colleges, and last for two years. There are three programs
available for registered nurses, including the Associate Degree in
Nursing( A.D.N), the Bachelor of Science in Nursing( B.S.N.) and
the diploma program. The associate degree in nursing (A.D.N.)
program is a two to three year program offered at junior and
community colleges and combined with hospital training. The
Bachelor of Science degree in nursing (B.S.N.) program is offered
at colleges and universities, and normally takes four to five years to
complete. And lastly, diploma programs are offered at hospitals,
and typically last from two to three years. Students are required to
graduate from an approved nursing program and pass a national
licensing examination to practice nursing. Periodic licensing
renewal is required, and usually involves continuing education and
additional training. It is important that nurses pursue higher
education in order to be eligible for promotions to supervisory and
higher paying roles. Also, a bachelor's degree is required to pursue
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a career as an advanced practice nurse such as a nurse

practitioner or certified nurse anesthetist.
2.6 The Transformation Factors To Commit Higher Education

In Nursing Profession.
2.6.1 The Need To Become Professional Profession.

Over time, the settings in which nurses are educated have
changed. Today, most nursing programs are located in institutions
of higher education or collegiate settings (at either colleges or
universities). Controversy over the length of nursing education
programs (associate degree versus baccalaureate degree) and the
“technical” aspects of patient care continues. Additionally, not all
nurses today are educated in colleges and universities. In
Malaysia, hospital based programs still provide an avenue to
nursing education for prospective nursing students but now we are
moving towards higher education such as minimum diploma and
now degree and even do master’s and doctoral in local and private
university. Even do there is growing numbers of master’s and
doctoral programs in nursing but its small compared with others
health profession. The legitimate question is ’How can nursing
take its place as a peer among the professions when the most
nurses currently in practice hold less than a baccalaureate
degree?’. The professional status and power comes and increase
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with postgraduate education. Education of nurses needs to change

to accommodate the increased expectations of nurses as
practitioners, educators, researchers, managers and administrators
as well as policy shapers. Flexner, Bixler’s & Bixler’s and Kelly
believed that practitioner needs to educate in Institution of Higher
Learning to become a peer profession.
2.6.2 The Growth Of Science And Technology. With the growth

of science and technology and the increase in complexity of
modern society, new fields of study have opened up to the
community via universities. Although nursing could not be seen as
a new science, technological advances and the explosion of
nursing and care models throughout the world has led to an
extraordinary increase in nursing knowledge and complexity. This
has resulted in the transfer of nurse preparation to higher education
with the view to ensuring nurses are prepared adequately to
guarantee safe practice. Preparation to degree levels is seen by the
nursing profession as a minimum standard. The requirement of
nurses to keep abreast with advancing technology and treatments
will increase the demand on the provision of higher education for
the profession.
2.6.3 Expectation of Community. A community should expect

that basic rights will be afforded it by its government. One of these
basic rights is access to quality health care. This can only be
provided in a system that is not only adequately funded but is
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provided by health professionals well grounded in knowledge and

skills required to provide that health care.
2.6.3 The Attributes Required By Nurses. These skills and

attributes can no longer be provided in an apprenticeship type
system, hence the transfer of nurse education to the higher
education sector. The attributes required by nurses to operate
effectively in their professional lives are:
a. Knowledge of clinical treatments for specific illnesses.
b..Awareness of and competence in emerging health
technology.
c. Skilled in counseling both patients and other nurses and

members of the health care team.
d. Ability to supervise other members of the health care team

in the care of patients.
e. An understanding of multiculturalism and the ability to

relate to people of many differing cultural backgrounds.
f. Ability to effectively manage both human and material
resources.
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g. The capacity to observe, act and interact appropriately

with a whole person, not just the illness or condition they
exhibit.
2.7 Implication of Higher Education to Nursing Profession
2.7.1 The Need of Health Industry. The health care industry is

one that is experiencing considerable growth, and as the population
continues to age, the need for provision of health care will expand.
It's been widely reported that there is a nursing shortage in the
United States, and it is expected to grow worse as the population
increases and ages and new medical procedures are developed.
Hospitals, nursing homes, adult-care facilities and home-care
services will suffer increasingly, industry experts say, as the current
trend seems likely to continue. Nursing faculties within Australian
universities have not kept pace with the health industry’s demand
for registered nurses and this has resulted in a shortfall of adequate
nursing numbers at both general and specialist level. This will
continue to have significant impact on workforce needs. A recent
workforce survey undertaken in Victoria, Australia shows a shortfall
of 516 effective full time positions in 412 facilities, this figure if
translated across the state results in one thousand unfilled nursing
positions. The major areas noted in the study as experiencing
particular difficulty in recruitment of nurses are operating theatres,
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critical care, accident and emergency, renal dialysis, rehabilitation,

midwifery and general medical and surgical units. Although some
of the nursing workforce shortages in Victoria can be attributed to
specific cuts to the health budget, Victorian nurses are also
extremely concerned at the significant cost of undertaking post
graduate studies in specialist nursing domains.
2.7.2 In Malaysia, we face two problems that is shortage of nurses

that we need to import foreign nurses and shortage of graduate
nurses. We have about 75,000 nurses nationwide, less than five
per cent of whom are graduates. The percentage of graduates we
need is actually about 10 per cent. Currently there is about one
nurse to care for 500 people but the industry is hoping to narrow
the gap to one nurse to 200.
2.7.3 Nursing as a Lifetime Commitment. Bixler and Bixler

(1945) emphasized in their list of criteria for professions that a
profession should attract people of certain intellectual and personal
qualities, who exalt service above personal gain and who consider
their chosen occupation to be their life work. Shortage of people
chooses these professions are increase. The higher education is
the one that can ensure the better pay, promotion, hierarchy in
upper position and other great career benefits. With these benefits,
the recruitment can be easier. The need of higher education brings
the changes in nursing curriculum. Today in Malaysia, hospital
based programs still provide an avenue to nursing education for
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prospective nursing students but now we are moving towards

higher education such as minimum diploma and now degree and
even doing master’s and doctoral in local and private university.
The nursing profession in Malaysia has also seen remarkable
progress over the years. In 1992, the nursing curriculum in our
colleges was upgraded from certificate to diploma levels. In the
same year the University of Malaya introduced the tertiary-level,
nursing degree programme. Today, we have 6 local universities
and 4 privately-owned colleges conducting the degree programme
for nurses. They are planning to expand its contribution to produce
more graduate nurses by offering a nursing degree through Long
Distance Learning and e - Learning. With all the programme will
allow Ministry of Health to retain its workforce while at the same
time upgrading their knowledge and skills . In 1994, the conversion
programme for the upgrading of assistant nurses to staff nurses
was introduced.Malaysia .
2.7.4 In terms of career development, nurses in Malaysia have

now been upgraded from being a support group to a professional
group with the creation of the degree scheme for nurses from U41
to U54 grades. This shows that the government acknowledges the
significant contribution of nurses (the higher education and
professional level) to the health of the nation. The good support
from government in Malaysia for nursing profession have
encourage and attract people of certain intellectual and personal
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qualities, who exalt service above personal gain and who consider
their chosen occupation to be their life work
2.7.5 Responsibility of Nursing Autonomy Body And

Authority. One of the responsibilities of nursing autonomy or
authority body is to promote and maintain the honors, interest and
the advancement of nursing as a profession. The bodies need to
double up their contribution to encourage nurse to grab the
opportunities with continuing studies up to graduate level. Others
policy they should remains and highlighted are:
a. To serve as the vehicle of integrated voice of the whole

profession to express its opinion and to acquaint the
government and other bodies with the policy and aspirations
of the nursing profession.
b..To promote nursing education, a high standard of nursing

practice and nursing research.
2.8 Recommendation
For this paper, I have three recommendation to be register, they

are:
2.8.1 Education Of Nurses Needs To Change To

Accommodate The Increased Expectations Of Nurses.
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Education of nurses needs to change to accommodate the

increased expectations of nurses as practitioners, educators,
researchers, managers and administrators as well as policy
shapers. The requirement of nurses to keep abreast with
advancing technology and treatments will increase the
demand on the provision of higher education for the
profession. Skills and attributes can no longer be provided
in an apprenticeship type system, hence the transfer of
nurse education to the higher education sector.
2.8.2 Government Policy Should Be Remaining. The

good support from government for nursing profession have
encourage and attract people of certain intellectual and
personal qualities, who exalt service above personal gain
and who consider their chosen occupation to be their life
work.
2.8.3 Responsibility of Nursing Autonomy Body And

Authority. The bodies need to maintain their contribution to
promote and encourage nurses to grab the opportunities
with continuing studies up to graduate level. Remain the
requirements to qualify for the higher level such as
applicants should have a diploma in nursing or equivalent
with a minimum of two years working experience, is currently
practising as a registered nurse.
2.9 Conclusion
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Nurses practice in the interest of public safety and provide a service

to society equally with other essential services such as the police
and army. The transfer of nurse education to the higher education
sector has provided a much needed stimulus to nursing research.
The continued availability of nurse researcher preparation through
the university process is essential for the continual addition of
nursing knowledge and evidence to nursing practice. As the
conclusions, I can say that the professional status and power
comes and increase with postgraduate education.
References:
1.Creasia, L. C., & Parker, B. (2001) The bridge to professional

nursing practice, conceptual foundations (3rd ed.). St Louis,
Sydney: Mosby.
2.Chan.M.C.,& Elicebat,P.L (2010) .NBBS 1203,Professionalism

and issues in Nursing B (Version March). Malaysia. Kuala Lumpur.
3..Malaysian Nursing Board website[Online][2010,July.01]
4.Trossman, S. (2002). The global reach of the nursing shortage.

American Journal of Nursing,102(3):85,87,89
5.Nafsiah Shamsudin. 30th Anniversary Invited Editorial Reflecting

on Smith J.P (1978) Higher education and nursing.Journal of
Advanced Nursing 3(3),219-220.
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3.0 Empowerment in Nursing - the Malaysian context
3.1 Introduction
In Malaysia the registered nurses represent the greatest number of
professional in a health care environment. In a world of ever
increasing technology advancement and economic constrains, the
need for solid rationale on which the base nursing interventions
cannot be ignored. Nurses need power to make their optimum
contribution and conclude with a discussion on the current state of
nursing empowerment related to nursing intervention.
Empowerment seems likely to provide for an umbrella concept of
professional development in nursing.
3.2 What is meant by empowerment in nursing
3.2.1 Defination of power
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From The Oxford English Dictionary power is define as “the ability

to do or effect something or anything, or to act upon a person or
thing”. Power as define by Grant(1994) is the capability of acting or

producing some sort of and effect, usually associated with the
ability to influence the allocation of scarce resources.
However, the use of power in nursing occurs as a phenomenon of
interpersonal relationships. Power is a central factor in
interpersonal communication.
Manojlovich(2007) give two definition for power in nursing. Power is
defined as having control, influence or domination over someone or
something and power is ability to mobilize resources in order to
attain the intended goals.
3.2.2 Defination of empowerment

From The Oxford English Dictionary empower defines as “to
invest legally or formally with power or authority”. Kramer and
Schmalenberg (1990) Empower defines as giving
Individuals the authority, responsibility, and freedom to act on what
they know and instilling in them belief and confidence in their own
ability to achieve and succed. The concept of empowerment are
wide - ranging: the term has been used to describe the essence of
human existence of and development, but also aspects of
organizational effectiveness and quality. The empowerment
ideology is rooted in social action where empowerment was
associated with community interests and with attempts to increase
the power and influence of oppressed group (such as workers,
women and ethnic minorities). Later there was also growing
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recognition of the importance of the individual’s characteristics and

actions.
3.2.3 Nurses’ Power over Nursing Practice

A historical review of nurses’ power over nursing practice should
include social, cultural, and education factors that influence nurses’
power over their practice. Social and cultural factors that influence
nursing power have their roots in the view of nursing as women’s
work(Wuest 1994). Nursing remain in a low status in the health
care hierarchy even in other profession can bring women on an
equal footing with men. Education factors contribute to this situation
where most of our nurses in Malaysia today are diploma graduate
and yet the multiple entry level into nursing practice further
dissipate whatever influence nursing may be able to generate.
From this educational factors may still be contributing to nursing’s
powerless.
Ongoing research on empower in nursing has demonstrated that
empowered nurses are “highly motivated and are able to motivate
and empower others by sharing the sources of power”(Laschinger
& Havens,1996).
3.3 Type of empowerment.

There are two Form of Empowerment :
3.3.1 Structural Empower
Structural power - oriented individuals sacrifice their own self -
interest for the good organization, feel a responsibility to build up
the organization, and have a strong sence of fairness and justice.
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Employees with a high need for power tend to be superior

perfomers, managers with a need for institution power tend to be
managing work groups that are productive and satisfied.(Steers &
Porter,1987)
Structural empowerment can be described as the structures (e.g.
policies, councils, and processes) within an organization that
empower nurses to practice in a professional and autonomous
manner to achieve the highest degree of clinical excellence and
professional fulfillment. With structural empowerment, the
organization has a commitment to continual learning and
educational and career advancement.
The theory of structural empowerment states that opportunity and
power in organizations are essential to empowerment, and must be
available to all employees for maximal organizational effectiveness
and success. The theory of structural empowerment was
developed by Kanter(1993) who saw employees’ work behavior as
arising from conditions and situations in the work place, and not
from personal attributes(Laschinger & Havens,1993). When
nurses have high level of power and opportunity that allow them to
complete their work in meaningful ways.
Structural sources of power have been used to explain power in

organization. Three main structural sources of power in
organizations have been identified as(Hoelzel):
1. Centerality: being central to the major function of the
organization and interconnected with the major systems.
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2. Control of uncertainty: influencing organizational goal attainment

by being able to cope with organization’s uncertain environment.
3. Control over resources, information, and other critical
organizational resourses
3.3.2 Psychological Empowerment

Psychological empowerment is seen as a process of personal
growth and development, which is influenced by individual beliefs,
views, values and perceptions and relationships with the
environment (Kuokkanen & Leino - Kilpi 2000)
Thus empowerment, as provided by the environment, tells part of
the story, but alone it is not enough. Some environments are
empowering because they allow workers to do what it is the worker
feel is necessary to get the job done. In other words, these
environments provide the sources of power. Other work
environments may not be as empowering, yet there will still be a
few hardy individuals who manage to do whatever it take to be
effective on the job. It may be that these people are able to
recognize what few empowering social structures can be used.
Manojlovich(2007).
Psychological power consists of the extent to which people believe
that they can influence even through personal effort. This means
knowing who they are, where they are going, what they want to
accomplish, as well as packaging themselves as person with power
and being adaptable.In a giving situation ,psychological power is
ability to assess the situation in managerial and political sense and
discern the degrees of decision freedom and the chances of being
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successful given any specific power strategy or leadership style. It

is also has been described as the extent to which followers respect,
are committed to, and are willing to follow a leader(Hersey et al.,
1996).Trust is the foundation of psychological empowerment.
3.4 Why Empowerment is needed

To be able to make their optimum contribution nurses need at least
three types of power.
3.4.1 Control Over the Content of Nursing Practice.

Power is an attribute that nurses must cultivate in order to practice
more autonomously because it is through power that members of
an occupation are able to raise their status, define their area of
expertise, and achieve and maintain autonomy and influence(Hall,
1982). One of the characteristics of profession is that professionals
have power over the practice of their discipline which is often
refered to as professional autonomy(Laschinger, Sabiston &
Kutszcher,1997). To identify the appropriate course of action and
effectively function, professionals must have understanding and
control over the entire spectrum of activities associated with the job
at hand (Manojlovich2005). However, it may be that nurses are
frequently unable to use their professional prepareation, which
focuses on autonomous practice and independent decision making,
because they are powerless relative to organizational
administrators and medical staff (Manojlovich).
3.4.2 Control Over the Context of Nursing Practice
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Besides control over the content of nursing practice, which

represents one type of power, a related type of control is known as
control over the context of practice, and represents another type of
power that nurses need (Laschinger et. Al.1997).
The positive findings of the magnet hospital research may be
attributed to empowering organizational social structures, although
they were not identified as such. Hospital characteristics which
were found to attract and retain qualified staff nurses included
decentralization and participatory decision making. :Although
relatively little attention has been paid to how a magnet work
environment contributes to nurses’ sense of power Upenieks,
2003).Professional practice models, shared governance models,
and collaborative governance all use similar processes to increase
nurses’ participation in decision making, thereby increasing their
control over the context of nursing practice and promoting power.
There is strong empirical justification for promoting nurses’ power
through control over both the content and context of nursing
practice. In multiple studies, patient outcomes were improved when
the hospital organization was supportive of autonomous nursing
practice(Aiken et. Al 1999; Aiken, Clarke, & Sloane, 2000).
3.4.3 Control Over the Competence of Nursing Practice

A necessary precursor for both autonomy and power is
competence , which has its foundation in education al preparation.
Power is maintained through knowledge development , which is
acquired through education and expertise. Educational preparation
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and expertise represent two additional type of power nurses need

to make their optimal contribution to patient care.
To increase nursing empowerment may lie in understanding
workplace sources of power, expanding the view of empowerment
to include the notion of empowerment as a motivational construct,
and finally making more explicit growth fostering relationships
which also contribute power. The importance of a positive work
environment for ensuring patient safety in hospital settings.
Creating and sustaining trust throughout the organization was
identified as a critically important leader activity. Structural
empowerment is identified as important for retaining nurses,
including job satisfaction, participant in organizational decision
making, job autonomy or control over practice and organizational
commitment.
3.5. AIM
Aiming for painless experience for hospitalization patients
“Any failure to relive pain is both morally and ethically
unacceptable”.
“All patients have a RIGHT to pain relief, creating a duty of
care”
(Royal College of surgeons and Anaesthetists .1990)
Pain is a very common symptom in hospitalize patients. Acute pain

is pain that associated with a distinct disease or injury. The aim
hospital organization and health care provider is to ovoid pain or
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reduce pain to all the patient. In recent years, there has been an
increasing trend for anaesthesiologist to take over the management
of acute pain. As a results ‘Acute Pain Services’ (APS) have been
set up in hospitals all over the world. This has resulted in better
management of postoperative and other form of acute pain.
In 1992 a survey was done in Hospital Kuala Lumpur and it
revealed that 55% of patient who had laparotomies had moderate
to severe pain post operatively with the management of surgeons
eg. Intra muscular pethedine 50mg 6 hourly. In Malaysia APS
service started in July 1993 by Department of Anaesthesiology to
manage postoperative and other forms of acute pain. APS has
evolved into a more organized service where it have Specialist
Anaesthetist, a medical officer and specialized APS nurses.
3 6. Disscussion
3.6.1 On Going Development of The Nursing Role
Health care professionals work within a system of

interdependent roles and collaborate with each other for the
common goal of quality health care. Effective management of
acute pain depends on close liaison with and education and
training of all staff, and involvement and education of the
patient and their care.
Empowering the APS nurse who was educated to make decisions
that provide effective around- the-clock pain management to
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patient base on medication or technique for pain as prescribe by

doctor.
Task and responsibilies undertaken by the APS nurse is to
advise on acute pain management to other nurses or patient if
pain control analgesia is indicated. APS also undertake regular
review of acute pain problem to ensure all the patient well manage
and all the machine in used are working eg. PCA machine,
perfussor. During round APS nurse need to assess the patient
regarding vital sign, pain assessment, sedation score and side
effect of medication.
APS nurse need to give bed side teaching of ward staff nurses and
supervise in the care of patient under acute pain management.
APS nurse must stress on pain assessment, sedation score, side
effect of the follow The Nursing Protocol that I attached at Appendix
1 to 6.
APS nurse need to deliver formal education for all disciplines with
medical colleagues and other health care professional.
In my hospital setting APS nurse have to liaise with consultant
anaesthetist with overall responsibility for acute pain management
such as to increase or decrease the dose of medication, advise to
change the route of medication, or to stop the medication.
When the nurses are empowered as a APS Nurse, it will improve
the management of acute, particularly post operative pain. This
will result in more comfortable patients, less post operative
complications and shortened hospital stay. With successful
empowerment for APS Nurse increasing their knowledge, skill,
confidence and competence.
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3.6.2. Empowerment is a an effective tool

The delivery of effective pain management has become a pressing
national issue in health care. Pain management is important
because it lessens pain experienced by the patient and reduces the
likelihood of physiological and psychological sequelae. In addition,
pain management may improve patient outcomes and increase
patient satisfaction.
Empowering the APS Nurse will lead to improving the patient care
with a good pain management or pain relief.
Beside having extensive professional knowledge ,nurses are
expected to be independent decision - makers engage in
continuous development of both themselves and their work. Other
consequences of nurses’ empowerment are accountability,
responsibility, willingness to see beyond the bedside, and the
pursuit of advocacy skills for patient.
Empowerment make APS Nurse co - ordinate the activities of ward
teams to ensure the highest standard of assessment, planning,
implementation and evaluation of individual patients encouraging
an environment of empowerment through coaching, teaching and
facilitating managing Acute Pain Service in the absence of the APS
Nurse.
Collecting data is part of APS Nurse responsibility to perform a
statistic as a imformation as knowledge about work goals, plans,
organization decisions, and change in policies. Nurse felt that
structural empowerment in their workplace resulted in higher levels
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of psychological empowerment. These heightened feelings of

psyhological empowerment in turn strongly influenced job strain
and work satisfaction.
For individual patients and their families, empowerment produces a
trusting, respectful, and nurturing nurse - patient relationship that
supply support, encouragement and imformation, but patients and
their families must accept responsibility for health care choices of
modilitis pain management.
3.6.3. Concepts of managing with empowerment
Structural empowerment states that opportunity and power in

organizations are essential to empowerment, and must be available
to all employees for maximal organizational effectiveness and
success.
The empowerment concept is a communcation concept bacause
the process of empowerment includes a connection with
individuals. .Although empowerment entail an individual needs,it is
nurtured by the outcome of mutual efforts(Kieffer,1984).Wallerstein
and Bernstein (1988) said that the empowerment includes more
environmental modification too. Team building and developing
human capacity are two key elements of achieving employee
empowerment. Nurses need opportunities for growth and
development. Nurses confidence and capability increase as people
gain additional experience in management and organization,as
well as develop new skills and knowledge, including the ability to
26
IN NURSING B )
effectively pass on this knowledge. It’s an ongoing process that

requires effort and dedication to improve working relationships,
thereby improving the overall effectiveness of the organization.
Leader or Specialist Anaesthetist need to recognize and believe in
the ability of their team members to utilize their good judgment and
expertise to act independently. At the same time, they must also
serve as a mediator and coach. Empowering APS Nurse is about
more than just participation, it also involves autonomous analysis,
decision making, and action. APS Nurse will have authority to
make independent decisions in their own expertise.
This is why true empowerment requires a great deal of respect,
trust and transparency.
Authority and enhancing self - confidence of the nurses also help

them to apply their knowledge in practice. Unification of the nurses
and their mutual support play the key roles in development of their
collective power and provide a base better working conditions,
professional independence and self regulation.
If the nurses getting empowered, the productivity and effectiveness

of nursing health care services will increase. Empowerment can
improve nurses skills, motivation, and they will creates comparative
advantage for the organization. The aim is to identify the
relationship between effective management by objective practices,
organizational productivity and nurses performance of the
organization.
3.6.4. Working in a positive, empowered atmosphere
27
IN NURSING B )
Organization support and trust has significant relationship with

psychological empowerment.. Supportive team is required to carry
out the mission of the organization or department. Organization
needs to provide subordinates with enough information about
organization goals, so that they understand how their efforts and
those are their manager are to contributing to goal attainment.
When the APS Nurse get the support, information, resources,
opportunities and autonomy made them feel empowered,
While this psychological empower occur the nurse feel empowered
to contribute to achieve organization goal.
Through careful manipulation of the hospital environment, both
structural and psychological empowerment can be increase,
resulting in greater job and patient satisfaction and ultimately
improve patient outcome.
Positive working atmosphere will lead the APS Nurse to self-
development by maximize on opportunities to continue education.
Positive work environment will be able to ensure patient safety in
hospital settings such as getting enough pain relief whenever they
got the pain. Good pain management given by APS Nurse will
reduces respiratory complication eg. Increase ability for deep
breathing and coughing, co - operate with chest physiotherapy,
decreased cardiovascular complication eg. Reduce tachycardia.
vasoconstriction, reduce incidence of DVT and pulmonary embolus
an reduce anxiety, anger and frustration.
Effort to improve nursing working conditions will be able to retaining
nurses and reduce shortage of staff problem.
28
IN NURSING B )
3.6.5. Implications to nursing profession

Empowerment to the nurses will develop confidence and
competencies in order to undertake responsibilities, of APS Nurse
jobs. The standard of care is effecting ongoing pain assessment
and pain management. The concept used as theorecal framework
is empowerment, which has widely been found useful not only in
developing patient care but also in education and also upgrade
personnel knowledge. Empowerment seems likely to provide for an
umbrella concept of professional development in nursing.
3.7 Recommendation
Pain is a very common symptom in hospitalizes patients. In order
to ovoid this empowering of APS nurse to manage the acute pain is
the recommended way. Effective relief of acute pain has been
shown to be important contributor to the rapid restoration of normal
functions, reduced incidence of complications and earlier discharge
from hospital. APS also will be able to promote doctor, patient and
nurse interaction which is provide better communication and better
Empowered APS nurse also able to provide better patient care with
individualized carer’ priority to pain assessment, better awareness
of pain, better management of pain and early ambulation.
In general, the smart concept building such as putting up posters,
pamphlets and reading materials regarding the importance of pain
management and the agents of choice both for pediatrics and
adults for the patient’s information can be used in these areas. By
29
IN NURSING B )
increasing the awareness of the public regarding this matter, their

cooperation during the procedure can be achieved to get the
expected outcome.
The staff involved in acute pain management either APS nurses or
ward nurses have to be more sensitive when dealing with the pain.
Beside pharmacology approach, psychology approach is very
crucial to develop rapport with patient. Simple approaches such as
gentle handling of the patient, eye contact and good communication
skills can be implemented to arrive at the objectives in reducing the
anxiety and suffering. Caring attitude shown by staff towards the
care of the patients help a lot in relieving pain.
Training and education in the pain assessment and management
should provided to all nurses in Intensive Care Unit, High
Dependency Unit, surgical ward and medical ward.
4.0 Conclusions:
These findings suggest that nursing organizations' efforts to create

empowering work environments can influence nurses' ability to
practice in a professional manner, ensuring excellent patient care
quality and positive organizational outcomes.
Nursing once again faces a serious shortage of nurses as
experienced nurses approach retirement and fewer individuals
enter the profession. Recent downsizing initiatives have often
resulted in heavier workloads for nurses, and reports of poor
working conditions, particularly in hospitals, abound in the media.
Patient safety is a major concern in this context in which fewer
nurses are available to care for patients with much higher acuity
30
IN NURSING B )
than in the past. To address this problem, efforts must be made to

improve nurses' working conditions to retain nurses in the system
and encourage new recruits to the profession.
References
2.McDonald .S et al (2010).Relationship Between Staff Nurses In

Organization Structures and Perception of Empowerment.Volume
33.148-162.
3.Rawal,N. Understand Component 11:Structural empowerment

[Online]Available:http://www.hcpro.com/NRS-228670-3238/
(1)Inside-the-program-Understand-Component-II-Structural-
empowerment.html.[20hb. June.2010]
4.Monojlovich.M.(2010).Power and empower in nursing.Journal of

issues in nursing.[Online] Available:http://www.nursing
31
IN NURSING B )
world.org/Main menu Categories/ANA Market place

(2010,June,10].
5. Creasia, L. C., & Parker, B. (2001) The bridge to professional

Sydney: Mosby.
32
IN NURSING B )
3.1 Introduction
In Malaysia the registered nurses represent the greatest number of
professional in a health care environment. In a world of ever
increasing technology advancement and economic constrains, the
need for solid rationale on which the base nursing interventions
cannot be ignored. Nurses need power to make their optimum
contribution and conclude with a discussion on the current state of
nursing empowerment related to nursing intervention.
Empowerment seems likely to provide for an umbrella concept of
professional development in nursing.
3.2 What is meant by empowerment in nursing
3.2.1 Defination of power

From The Oxford English Dictionary power is define as “the ability
to do or effect something or anything, or to act upon a person or
thing”. Power as define by Grant(1994) is the capability of acting or

producing some sort of and effect, usually associated with the
ability to influence the allocation of scarce resources.
However, the use of power in nursing occurs as a phenomenon of
interpersonal relationships. Power is a central factor in
interpersonal communication.
Manojlovich(2007) give two definition for power in nursing. Power is
defined as having control, influence or domination over someone or
33
IN NURSING B )
something and power is ability to mobilize resources in order to

attain the intended goals.
3.2.2 Defination of empowerment

From The Oxford English Dictionary empower defines as “to
invest legally or formally with power or authority”. Kramer and
Schmalenberg (1990) Empower defines as giving
Individuals the authority, responsibility, and freedom to act on what
they know and instilling in them belief and confidence in their own
ability to achieve and succed. The concept of empowerment are
wide - ranging: the term has been used to describe the essence of
human existence of and development, but also aspects of
organizational effectiveness and quality. The empowerment
ideology is rooted in social action where empowerment was
associated with community interests and with attempts to increase
the power and influence of oppressed group (such as workers,
women and ethnic minorities). Later there was also growing
recognition of the importance of the individual’s characteristics and
actions.
3.2.3 Nurses’ Power over Nursing Practice

A historical review of nurses’ power over nursing practice should
include social, cultural, and education factors that influence nurses’
power over their practice. Social and cultural factors that influence
nursing power have their roots in the view of nursing as women’s
work(Wuest 1994). Nursing remain in a low status in the health
care hierarchy even in other profession can bring women on an
34
IN NURSING B )
equal footing with men. Education factors contribute to this situation

where most of our nurses in Malaysia today are diploma graduate
and yet the multiple entry level into nursing practice further
dissipate whatever influence nursing may be able to generate.
From this educational factors may still be contributing to nursing’s
powerless.
Ongoing research on empower in nursing has demonstrated that
empowered nurses are “highly motivated and are able to motivate
and empower others by sharing the sources of power”(Laschinger
& Havens,1996).
3.3 Type of empowerment.

There are two Form of Empowerment :
3.3.1 Structural Empower
Structural power - oriented individuals sacrifice their own self -
interest for the good organization, feel a responsibility to build up
the organization, and have a strong sence of fairness and justice.
Employees with a high need for power tend to be superior
perfomers, managers with a need for institution power tend to be
managing work groups that are productive and satisfied.(Steers &
Porter,1987)
Structural empowerment can be described as the structures (e.g.
policies, councils, and processes) within an organization that
empower nurses to practice in a professional and autonomous
manner to achieve the highest degree of clinical excellence and
professional fulfillment. With structural empowerment, the
35
IN NURSING B )
organization has a commitment to continual learning and

educational and career advancement.
The theory of structural empowerment states that opportunity and
power in organizations are essential to empowerment, and must be
available to all employees for maximal organizational effectiveness
and success. The theory of structural empowerment was
developed by Kanter(1993) who saw employees’ work behavior as
arising from conditions and situations in the work place, and not
from personal attributes(Laschinger & Havens,1993). When
nurses have high level of power and opportunity that allow them to
complete their work in meaningful ways.
Structural sources of power have been used to explain power in

organization. Three main structural sources of power in
organizations have been identified as(Hoelzel):
1. Centerality: being central to the major function of the
organization and interconnected with the major systems.
2. Control of uncertainty: influencing organizational goal attainment
by being able to cope with organization’s uncertain environment.
3. Control over resources, information, and other critical
organizational resourses
3.3.2 Psychological Empowerment

Psychological empowerment is seen as a process of personal
growth and development, which is influenced by individual beliefs,
views, values and perceptions and relationships with the
environment (Kuokkanen & Leino - Kilpi 2000)
36
IN NURSING B )
Thus empowerment, as provided by the environment, tells part of

the story, but alone it is not enough. Some environments are
empowering because they allow workers to do what it is the worker
feel is necessary to get the job done. In other words, these
environments provide the sources of power. Other work
environments may not be as empowering, yet there will still be a
few hardy individuals who manage to do whatever it take to be
effective on the job. It may be that these people are able to
recognize what few empowering social structures can be used.
Manojlovich(2007).
Psychological power consists of the extent to which people believe
that they can influence even through personal effort. This means
knowing who they are, where they are going, what they want to
accomplish, as well as packaging themselves as person with power
and being adaptable.In a giving situation ,psychological power is
ability to assess the situation in managerial and political sense and
discern the degrees of decision freedom and the chances of being
successful given any specific power strategy or leadership style. It
is also has been described as the extent to which followers respect,
are committed to, and are willing to follow a leader(Hersey et al.,
1996).Trust is the foundation of psychological empowerment.
3.4 Why Empowerment is needed

To be able to make their optimum contribution nurses need at least
three types of power.
3.4.1 Control Over the Content of Nursing Practice.
37
IN NURSING B )
Power is an attribute that nurses must cultivate in order to practice

more autonomously because it is through power that members of
an occupation are able to raise their status, define their area of
expertise, and achieve and maintain autonomy and influence(Hall,
1982). One of the characteristics of profession is that professionals
have power over the practice of their discipline which is often
refered to as professional autonomy(Laschinger, Sabiston &
Kutszcher,1997). To identify the appropriate course of action and
effectively function, professionals must have understanding and
control over the entire spectrum of activities associated with the job
at hand (Manojlovich2005). However, it may be that nurses are
frequently unable to use their professional prepareation, which
focuses on autonomous practice and independent decision making,
because they are powerless relative to organizational
administrators and medical staff (Manojlovich).
3.4.2 Control Over the Context of Nursing Practice

Besides control over the content of nursing practice, which
represents one type of power, a related type of control is known as
control over the context of practice, and represents another type of
power that nurses need (Laschinger et. Al.1997).
The positive findings of the magnet hospital research may be
attributed to empowering organizational social structures, although
they were not identified as such. Hospital characteristics which
were found to attract and retain qualified staff nurses included
decentralization and participatory decision making. :Although
relatively little attention has been paid to how a magnet work
38
IN NURSING B )
environment contributes to nurses’ sense of power Upenieks,

2003).Professional practice models, shared governance models,
and collaborative governance all use similar processes to increase
nurses’ participation in decision making, thereby increasing their
control over the context of nursing practice and promoting power.
There is strong empirical justification for promoting nurses’ power
through control over both the content and context of nursing
practice. In multiple studies, patient outcomes were improved when
the hospital organization was supportive of autonomous nursing
practice(Aiken et. Al 1999; Aiken, Clarke, & Sloane, 2000).
3.4.3 Control Over the Competence of Nursing Practice

A necessary precursor for both autonomy and power is
competence , which has its foundation in education al preparation.
Power is maintained through knowledge development , which is
acquired through education and expertise. Educational preparation
and expertise represent two additional type of power nurses need
to make their optimal contribution to patient care.
To increase nursing empowerment may lie in understanding
workplace sources of power, expanding the view of empowerment
to include the notion of empowerment as a motivational construct,
and finally making more explicit growth fostering relationships
which also contribute power. The importance of a positive work
environment for ensuring patient safety in hospital settings.
Creating and sustaining trust throughout the organization was
identified as a critically important leader activity. Structural
empowerment is identified as important for retaining nurses,
39
IN NURSING B )
including job satisfaction, participant in organizational decision

making, job autonomy or control over practice and organizational
commitment.
3.5 The issue related to empowerment in nursing in my

workplace.
The related issue which I interested to highlight is to create
empowering work environments which can influence nurses' ability
to practice in a professional manner, ensuring excellent patient care
It is being increasingly recognized that the solution to the problem

of inadequate postoperative and acute pain relief liaise not so
much in development of new techniques but in development of a
formal organization for better use of existing techniques. Acute
Pain Services (APS) are being increasingly established to provide
good quality postoperative analgesia.
3,5.1 Defination of pain

Merskey (1964) define pain as “An unplessant sensory and
emotional experience associated with actual or potential tissue
damage, or described in term of such damage”.
i) Sensory – feeling and sensation
ii) Emotional – psychological aspect
iii) Pathophysiology – tissue damage – actual, potential
Pain is a very common symptom in hospitalize patients. Acute pain
is pain that associated with a distinct disease or injury. Traditionally,
40
IN NURSING B )
surgeons have been treating acute pain, particularly postoperative

pain.With increased awareness about detrimental effect of pain and
a better understanding of pain physiology has led to
recommendatios of early, aggressive analgesic intervention for
post-surgical.
“Any failure to relive pain is both morally and ethically

unacceptable”.
“All patients have a RIGHT to pain relief, creating a duty of
care”
(Royal College of surgeons and Anaesthetists .1990)
In recent years, there has been an increasing trend for

anaesthesiologist to take over the management of acute pain. As a
results ‘Acute Pain Services’ have been set up in hospitals all over
the world. This has resulted in better management of postoperative
and other form of acute pain.
In 1992 a survey was done in Hospital Kuala Lumpur and it

revealed that 55% of patient who had laparotomies had moderate
to severe pain post operatively with the management of surgeons
eg. Intra muscular pethedine 50mg 6 hourly. In Malaysia APS
service started in July 1993 by Department of Anaesthesiology to
manage postoperative and other forms of acute pain. APS has
evolved into a more organized service where it have Specialist
Anaesthetist, a medical officer and specialized APS nurses. Our
nurse - based anesthesiologist - supervised model is base on the
41
IN NURSING B )
concept that postoperative pain relief and acute pain relief can be
greatly improved by provision of in - service training for surgical
nursing staff, optimal use of systemic opiods and use of regional
analgesia techniques and Patient Control Anaesthesia in selected
patients.
3.5.2 Personnel of Acute Pain Service (APS)

The staffing of an APS should be based upon the following
considerations:
a. Consultant anaesthetist, who is responsible for provision of the
service. The job of consultant is in pain management.
b. The APS nurse to advise on pain management and to undertake
a program of regular review of acute pain problems. The APS nurse
should also be responsible for the day to day organization of the
APS.
c. The provision of effective acute pain management can be
optimized by collaboration with colleagues from pharmacy
department.
3.5.3 Modilities of analgesia
1.Conventional methods
a. Oral analgesic : Opiod eg. Morphine. Codine, pethidine
Non steroidal anti imflammatory drugs (NSAIDs) eg. Ponstan,
Synflex.
42
IN NURSING B )
b. Intramuscular : Opiod
: Non steroidal anti imflammatory drugs
(NSAIDs)
c. Per ractal
d. Transdermal
2. Newer techniques
a. Subcutaneous opiod
b. Patient control analgesia (PCA)
c. Epidural analgesia
3.5.4 Why treat pain?
1.Early return to normal function.

2.Humanitarian aspect of relieving pain.
3.Reduces respiratory complication eg. Increased ability for deep
breathing and coughing, co - operate with chest physiotherapy.
4.Decreased Cardiovascular complication eg. Reduced
thachycardia, vasoconstriction, afterload & myocardial workload.
5.Increased mobility, reduce incidence of DVT and pulmonary
embolus.
6.Early oral intake.
7.Reduced anxiety, anger & frustration.
43
IN NURSING B )
3.5.5 The role of the Acute pain Service
1.To improve the management of acute, particularly postoperative

pain by introducing new methods and improving old methods of
pain relief. This will result in more comfortable patients, less
postoperative complications and shortened hospital stay.
2.To organize the monitoring necessary for patients, including pain
and sedation scores.
3.To train hospital staff in the management of acute pain - this
includes ward nurses, surgeons, anaesthetists, medical and house
officers and trainee paramedic staff.
4.To provide standardized protocols in various techniques of acute
pain management including the early detection and management
of complications. This will minimize the adverse sffects
associated with the provision of good pain relief.
5.To provide standardized protocols in postoperative pain
management.
3.5.6 APS nurse responsibility

1. Advice on acute pain management.
2. Undertake regular review of acute pain problems.
3. Undertake education of ward nurses by supervision in the care of
patient under APS
4. Deliver formal education for all disciplines with medical
colleagues and other health care professional.
5. Liaise with consultant anaesthetist with overall responsibility for
acute pain management.care.
44
IN NURSING B )
3.5.7 Modilities of analgesia for APS in my work place

1. Subcuteneous morphine
G 23 or 22 butterfly needle cannula insert at infraclavicular or
outer aspect of the
Aim. Dosage 2.5 mg - 10 mg Morphine undiluted 4 hourly.
a. Advantage
i. Reasonable good pain relief
ii. Less pain on injection
iii. Easy to give and no needle
iv. Patient can be mobile
v. Cheap
b. Disadvantage
i. Onset slow
ii. Over - sedation
iii. Nausea and vomiting
iv. Occasional pain on injection ( esp. Pethidine)
2. Patient control analgesia (PCA)
Morphine 1mg/ml or pethidine 10mg/ml given intravenously and
control by patient using PCA mechine. Only patient can press
the button and patient should mentally alert and able to comply
with instruction. PCA delivered by a dedicated IV line or a
one way ‘Anti - Reflux’ valve is used if the IV line is shared. PCA
mechine must be locked and lockout interval at least 5 minutes.
a. Advantages
i. Effective for severe pain
ii. Involves patient participation
45
IN NURSING B )
iii.Safe and reliable technique

iv. Dose according to patient’s need
v. Nursing is easier
b. Disadvantages
i. High cost of PCA machine and tubing
ii. Need to educate patients and relatives
iii. Still need regular monitoring
iv. Not suitable for all patients
c. Contraindication
i. Patient refuse PCA
ii. Patient does not know how to use it e.g. Senile, small children
iii. Unable to use PCA mechine e.g. Head injured, both hand
plastered
iv. Untrained staff
3. Central neuraxial (epidural & intrathecal) analgesia
-Epidural - Intruducing analgesic drug (opioid, local
anaesthetic,combined opiod and local anaesthetic) into the
epidural space(use cateter).
-Intrathecal - Intruducing analgesic drug into subarachnoid(single
shot).
Epidural opioid commonly used in my hospital. Opioid will diffuse
through the dura into the CSF and act on specific opioid
receptors in the spinal cord.
a. Advantage
i. Very effective for severe pain
ii. Less problems with nausea/vomiting
iii.Little central sedation effect
46
IN NURSING B )
b. Disadvantage
i. Not for all type of surgery
ii. High cost of equipment
iii.Need skill in inserting epidural
iv.Risk of infection
v. Risk of delayed respiratory depression
vi.Required skilled nurses.
3.6 Nursing observation

It is very important for early detection of serious side effects and to
make sure patient is effectively treated.
3.6.1 What to observe?

i. Vital sign (BP/ pulse) hourly for the first 4 hours then 4 hourly.
ii. Respiration rate - to observe for side effect of opioid respiratory
depression.
iii. Sedation score
0 = None (awake/alert)
1 = Mild ( occasionally drowsy)
2 = Moderate (frequent drowsy but arousable)
3 = Severe (difficult to arouse)
4 = Sleeping
iv. Pain score
a. Verbal numerical pain score
0 = None
47
IN NURSING B )
1 = Slight pain
2 = Tolerable pain
3 = Severe pain
4 = Worst pain imaginable
b. Visual analogue score
Using the ruler with the whole scale is 10 cm.
c. Verbal analogue score
Patient gives a number for her pain on a scale from zero to
ten. The number is recorded as a pain score.
d. Functional score
To assess what function the patient can do with the pain.
Can you cough?
Can you breathe deeply?
Can you sit?
e. Observation pain score
Usually used for paediatrics. Observation of respiratory
rate, heart rate, crying, calm/restless, sleeping or trashing.
v. Side effect e.g. urine retention, post operative nausea and
vomiting, pruritis, motor blockade, hypotension.
vi..Check the injection site: not inflamed, swelling, painful, catheter
insitu and clearly labeled.
Nursing Procedure Protocol

Attached at Appendix 1 - 6
48
IN NURSING B )
Recommandition
Pain is a very common symptom in hospitalises patients.In order to
ovoid this empowering of APS nurse to manage the acute pain is
the recommended way.Effective relief of acute pain has been
shown to be important contributor to the rapid restoration of normal
funcition, reduced incidence of complications and earlier discharge
from hospital. APS also will be able to promote doctor, patient and
nurse interaction which is provide better communication and better
Empowered APS nurse also able to provide better patient care with
individualized carer’ priority to pain assessment, better awareness
of pain, better management of pain and early ambulation.
In general, the smart concept building such as putting up posters,
pamphlets and reading materials regarding the importance of pain
management and the agents of choice both for pediatrics and
adults for the patient’s information can be used in these areas. By
increasing the awareness of the public regarding this matter, their
cooperation during the procedure can be achieved to get the
expected outcome.
The staff involved in acute pain management either APS nurses or
ward nurses have to be more sensitive when dealing with the pain.
Beside pharmacology approach, psychology approach is very
crucial to develop rapport with patient. Simple approaches such as
gentle handling of the patient, eye contact and good communication
skills can be implemented to arrive at the objectives in reducing the
49
IN NURSING B )
anxiety and suffering. Caring attitude shown by staff towards the

care of the patients help a lot in relieving pain.
Training and education in the pain assessment and management
should provided to all nurses in Intensive Care Unit, High
Dependency Unit, surgical ward and medical ward.
4.0 Conclusions:
These findings suggest that nursing organizations' efforts to create

empowering work environments can influence nurses' ability to
practice in a professional manner, ensuring excellent patient care
Nursing once again faces a serious shortage of nurses as
experienced nurses approach retirement and fewer individuals
enter the profession. Recent downsizing initiatives have often
resulted in heavier workloads for nurses, and reports of poor
working conditions, particularly in hospitals, abound in the media.
Patient safety is a major concern in this context in which fewer
nurses are available to care for patients with much higher acuity
than in the past. To address this problem, efforts must be made to
improve nurses' working conditions to retain nurses in the system
and encourage new recruits to the profession.
Magnet hospital research has shown that nurses are attracted to
hospital work environments that promote autonomy and control
over the practice environment and that foster good nurse-physician
relationships.
50
IN NURSING B )
Hospital nurses who perceive themselves to be structurally and

psychologically empowered are more likely to feel respected in the
workplace.
Changing workplace structures is within the mandate of nurse
managers in their roles as advocates for and facilitators of high-
quality care. Nurse managers have the influence and resources to
facilitate empowering work conditions that can increase nurses'
feelings of being respected. In addition, promoting collaborative
inter-professional and intra-professional relationships and assuring
continuous support to nurses are particularly important strategies
for building respect.
51
IN NURSING B )
References
2.McDonald .S et al (2010).Relationship Between Staff Nurses In

Organization Structures and Perception of Empowerment.Volume
33.148-162.
3.Rawal,N. Understand Component 11:Structural empowerment

[Online]Available:http://www.hcpro.com/NRS-228670-3238/
(1)Inside-the-program-Understand-Component-II-Structural-
empowerment.html.[20hb. June.2010]
4.Monojlovich.M.(2010).Power and empower in nursing.Journal of

issues in nursing.[Online] Available:http://www.nursing
world.org/Main menu Categories/ANA Market place
(2010,June,10].
5. Creasia, L. C., & Parker, B. (2001) The bridge to professional

Sydney: Mosby.
52
IN NURSING B )
53

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NBNC 1204 CLINICAL PRACTICE 10 (PROFESSIONALISM AND ISSUES 2010

Nursing Professionalism / Professionalisation in Malaysia

“ The Lady with the Lamp,”which it is address to Florence

Nurses provide a variety of services to their patients. In general,

2.21 - Nursing professionalism

Professionalism refers to the conducts, goals or qualities that

Profession usually develops codes of ethic that describe the

Professionalism in nursing are set of rules, work ethics, ideologies,

2.22 - Nursing Professionlisation

Professionalisation is a process through which an occupation goes

During the twentieth century, the nursing profession has under

According to Colyer,(2004) These changes can be characterized as

the hierarchy) towards greater role divertsity and a more

Becoming a professional involves unique training, formal education,

2.3. Nursing issue in Higher Education

Nursing issue in Higher Education is identify relating in clinical

In this paper, I will try to highlight the need of higher education in

of employment. Earliest programs of education were located in

2.5.1 A Day In Nursing Life. Nurses work in many different

2.5.2 Education and training.

Over time, the settings in which nurses are educated have

a career as an advanced practice nurse such as a nurse

2.6 The Transformation Factors To Commit Higher Education

2.6.1 The Need To Become Professional Profession.

with postgraduate education. Education of nurses needs to change

2.6.2 The Growth Of Science And Technology. With the growth

2.6.3 Expectation of Community. A community should expect

provided by health professionals well grounded in knowledge and

2.6.3 The Attributes Required By Nurses. These skills and

a. Knowledge of clinical treatments for specific illnesses.

b..Awareness of and competence in emerging health

c. Skilled in counseling both patients and other nurses and

d. Ability to supervise other members of the health care team

e. An understanding of multiculturalism and the ability to

f. Ability to effectively manage both human and material

g. The capacity to observe, act and interact appropriately

2.7 Implication of Higher Education to Nursing Profession

2.7.1 The Need of Health Industry. The health care industry is

critical care, accident and emergency, renal dialysis, rehabilitation,

2.7.2 In Malaysia, we face two problems that is shortage of nurses

2.7.3 Nursing as a Lifetime Commitment. Bixler and Bixler

prospective nursing students but now we are moving towards

2.7.4 In terms of career development, nurses in Malaysia have

2.7.5 Responsibility of Nursing Autonomy Body And

a. To serve as the vehicle of integrated voice of the whole

b..To promote nursing education, a high standard of nursing

For this paper, I have three recommendation to be register, they

2.8.1 Education Of Nurses Needs To Change To

Education of nurses needs to change to accommodate the

2.8.2 Government Policy Should Be Remaining. The

2.8.3 Responsibility of Nursing Autonomy Body And

Nurses practice in the interest of public safety and provide a service

1.Creasia, L. C., & Parker, B. (2001) The bridge to professional

2.Chan.M.C.,& Elicebat,P.L (2010) .NBBS 1203,Professionalism

3..Malaysian Nursing Board website[Online][2010,July.01]

4.Trossman, S. (2002). The global reach of the nursing shortage.

5.Nafsiah Shamsudin. 30th Anniversary Invited Editorial Reflecting

3.0 Empowerment in Nursing - the Malaysian context

3.2 What is meant by empowerment in nursing

3.2.1 Defination of power

From The Oxford English Dictionary power is define as “the ability

thing”. Power as define by Grant(1994) is the capability of acting or

3.2.2 Defination of empowerment