Psychological Empowerment and its Associated Factors among Operational Staff of Tehran Emergency Center
Aram Ghaniyoun1, Mohammad Heidari2, Khosro Shakeri3
1 PhD Student in Governmental Management, Department of Management, College of Human Science, Saveh Branch, Islamic Azad University, Saveh, Iran.
2 Lecturer, Department of Medical and Surgical School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran.
3 PhD Candidate in Health in Emergency and Disaster, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Mohammad Heidari, Ayatollah Kashani Blvd, Shahrekord University of Medical Sciences, Shahrekord, Iran.
E-mail: mo.heydari@yahoo.com; heidari@skums.ac.ir
Introduction
Emergency medical personnel often face chronic stress which, in many situations causes psychological problems. In this regard, psychological empowerment can reduce psychological tensions in health care environment through increasing efficiency and motivation.
Aim
To investigate psychological empowerment and its related factors in operational staff of Tehran Emergency Center (TEC).
Materials and Methods
In this analytical study, a total of 285 people were selected by simple sampling method from 1100 operational staff of TEC. Data was collected using demographic information and Spritzer’s psychological empowerment questionnaire. SPSS/19 software and descriptive analytical tests were used for data analysis.
Results
The findings suggested that most of the participants (46%) were in intermediate level in terms of psychological empowerment, and the mean score of psychological empowerment in participants was 46.43. A significant correlation was found between the dimension of self-determination of psychological empowerment and work experience (p<0.05).
Conclusion
Owing to the critical duties of medical emergency centers in maintaining and improving public health, and based on the findings of this study, it is recommended that the authorities should pay more attention to the capabilities of the staff while giving responsibilities to them and to conduct effective planning in this regard.
Introduction
Psychological empowerment is a process of enhancing intrinsic occupational motivation that includes four cognitive fields-feeling of effectiveness, meaningfulness, competency and the right of choice [1], and it is interpreted as an intrinsic psychological and motivational state. The employees have a sense of control over their work and this feeling, arising from intrinsic motivation, makes them an active member of the organization. In other words, as they improve their self-esteem, they dominate their sense of frustration and weakness and do their activities with more responsibility and freedom [2,3]. Empowerment is an organizational strategy that grants greater responsibility to employees for decision-making and enhance their contribution in managing organizational processes [4]. Empowered employees, individually and collectively, are responsible about their work and its results, and have more job satisfaction compared to non-empowered employees [5]. Psychological empowerment approach focuses on employees’ perception of empowerment and elaborates how empowerment is perceived by staff and their subordinates. Empowerment can lead to attitudinal (job satisfaction and reducing stress) and behavioral outcomes for people regarding their occupation [6]. Accidents are one of the major problems of public health around the world.
Several organizations have been found to protect public health by performing their duties, each of them fulfils their crucial responsibilities. In this regard, medical emergency management center can be mentioned which provides health care for patients in emergency situations [7]. Medical emergency staff often faces chronic stress, such as exposure to injury, lack of consciousness or even death of the patient. Many of these situations, often are a source of stress for emergency staff [8,9]. In other words, working environment is associated with environmental excitement accompanied by negative stress for emergency staff who should attend the accident site, and if the service location be in a remote area, it will become an anxiety factor which is often associated with mental and physical excitement for the employees [10-12]. However, it seems that psychological empowerment in mental dimension can cause a change in the attitudes and prejudices of the health personnel and lead to different consequences. In other words, psychological empowerment, as a motivator factor, increase their performance capacity [13]. Empowerment of emergency care personnel helps them to use their maximum capacity in reaching the goals of health centers [14]. Therefore, considering the importance of evaluating psychological empowerment in operational staff of emergency center, as the pivotal parts of health services, and with respect to limited studies in this regard, this study was conducted to assess psychological empowerment and its related factors in operational staff of TEC.
Materials and Methods
This analytical study was conducted to determine psychological empowerment and its associated factors in operational staff of TEC. The sample size was estimated as 285, with a confidence interval of 95% and a sampling error of 5%. The study population was 1100 operational staff of TEC in November 2014 to July 2015. The participants were selected and included in the study from this population by simple random sampling method.
The inclusion criteria were as follows: at least one year of working experience in pre-hospital emergency; a warrant of formal, by contract, by proposal, or corporative employment; and working in operational field as emergency medical technician with degrees from diploma to professional doctorate. After selecting the eligible subjects, and introduction of the researcher, the aim of the study was elucidated by the investigator. The questionnaire was given to the participants after providing the written informed consent, and reassuring them that their information will remain confidential. Data was collected using two-part questionnaire of demographic information and Spreitzer’s psychological empowerment. Psychological empowerment questionnaire is developed by Spreitzer [15]. This questionnaire consists of 12 questions (3 questions in each dimension) in a Likert scale of 4 degrees (from 1 to 4) that the lowest level of capability is demonstrated with score of 1 and highest level of capability is represented with a score of 4. The score is a number between 1 to 4, while the fifth choice refers to “I had no exposure” [16]. The questionnaire was first used in Iran by Eskandari et al., after that the permission was granted by the creator and the tool was translated to Persian. They reported tool’s validity and reliability indices as 0.92 and 0.73, respectively [17] . In the present study, the questionnaire’s (Persian version) reliability by alpha Cronbach’s method, after giving the questionnaire to 30 participants, was reported as follows: 0.83 for empowerment, 0.83 for sense of competence, 0.83 for Independence, 0.83 for job impact, and 0.84 for job meaning. Analysis of raw data was conducted by SPSS/19 software, and descriptive and inferential tests.
Results
The mean psychological empowerment score of participants was 46.43. The distribution of psychological empowerment amongst operational staff of TEC demonstrated that the majority of them (46%) were in medium level in terms of empowerment [Table/Fig-1]. Besides, the Frequency of the dimensions (Sense of competence, Self-determination and Occupation impact) is shown in [Table/Fig-2].
Frequency of psychological empowerment.
| Index Level | N | % | Valid percentage | Cumulative percentage |
|---|
| Low (12-28) | 100 | 35.1 | 35.1 | 35.1 |
| Moderate (29-44) | 131 | 46 | 46 | 81.1 |
| High (45-60) | 54 | 18.9 | 18.9 | 100 |
| Total | 285 | 100 | 100 | - |
Frequency of sense of competence, self-determination and occupation impact in operational staff of TEC.
| Dimensions | Level | F | % | Mean |
|---|
| Sense of competence | Low | 12 | 4.2 | 13.8 |
| Moderate | 273 | 95.8 |
| Total | 285 | 100 |
| Self-determination | Low | 152 | 53.3 | 10.87 |
| Moderate | 133 | 46.7 |
| Total | 285 | 100 |
| Occupation impact | Low | 21 | 7.4 | 9.86 |
| Moderate | 172 | 60.4 |
| High | 92 | 32.3 |
| Total | 285 | 100 |
Since only male employees work in operational domain of TEC, all the participants in this study were male. The majority of the participants (44.5%) aged 31-40 years and had less than 5 years of work experience (34%). Other demographic data are presented in [Table/Fig-3].
Sample characteristics (n=285).
| Variables | Frequency N % |
|---|
| Marital status | Single | 82(28.8) |
| Married | 203(71.2) |
| Age (years) | 20-30 | 94(33) |
| 31-40 | 127(44.5) |
| 41-54 | 64(22.5) |
| Level of Education | Diploma | 51(17.9) |
| Associate | 143(50.2) |
| Bachelor | 87(30.5) |
| Master | 4(1.4) |
| Work experience (years) | 5> | 97(34) |
| 5-10 | 90(31.6) |
| 10-15 | 69(24.2) |
| 15& | 29(10.2) |
Based on the findings of this study, the mean psychological empowerment score of participants was 46.43. In evaluation of the association of psychological empowerment and demographic parameters in operational staff of TEC, the findings indicated that the age (p=0.35), marital status (p=0.42), and education level (p=0.52) of participants have no significant relationship with their score of empowerment perception in dimensions of meaning, competence, independence, and overall psychological empowerment. Besides, no significant relationship was noted between work experience and score of psychological empowerment in dimensions of meaning, competence, and psychological empowerment overall. However, in independence dimension, by increasing work experience of staff to more than 10 years, the empowerment perception score increased (p=<0.001) [Table/Fig-4].
The relationship between psychological empowerment scores with demographic characteristics.
| Variable | Mean | SD | p-value |
|---|
| Age | 1.43 | 0.535 | 0.35 |
| Education level | 1.35 | 0.682 | 0.52 |
| Work experience | 1.27 | 0.713 | <0.001 |
| Marital status | 1.32 | 0.615 | 0.42 |
* One-way ANOVA test was used to calculate the p-value
Discussion
In the present study, the majority of the employees (46%) had medium levels of empowerment indices. Knol and Van Linge believe that empowering employees improves their job satisfaction, organizational commitment, innovation, and performance [18]. Flesner et al., in their research results, stated that in clinical settings care is of higher importance, the caregiver should feel more empowered due to the conditions [19]. In line with this study, Abedsaeedi et al., reported empowerment environment to be in intermediate level, in their study that was conducted in emergency medical centers [20]. The results of previous studies on the influence of psychological empowerment is consistent with present study [21]. However, Nasiripour AA et al., in their study on psychological conditions in hospitals in Qom province, stated that in terms of empowerment components, hospitals’ staff were in good condition with a mean of 3.89 [22].
There was no significant correlation between age, marital status, and education level with scores of psychological empowerment’s perception in dimensions of meaning, competence, independence, impact, and overall empowerment. Similar to our findings, no significant relationship was noted between psychological empowerment and individual variables in Spence Laschinger et al., study [23]. Laschinger et al., also found the relationship between psychological empowerment and years of service to be significant. They declare that experience factor plays an important role in empowering people with the passage of time [23,24]. Based on Spreitzer’s point of view, work experience can be considered a main factor that affects employees’ empowerment. The employees with more working experience, can better adjust themselves to different working conditions, since they benefit from past experience [25]. Considering the independence dimension of psychological empowerment, it may be noted that the years of service in emergency medicine can improve the empowerment level in independence dimension. Emergency medicine staff, can acquire the required independence in the workplace, since they face different conditions and gain work experience in this regard [17]. In the present study, the sense of competence dimension had more mean (13.8%) compared to other dimensions. In other words, medical emergency staff have robust sense of competence along with skills and abilities to perform their duties, which is in line with Spence Laschinger et al., and Eskandari et al., studies [17,23]. However, this study was conducted only in a special place in Iran which can be regarded as a limitation. It is recommended that qualitative research be conducted in order to further evaluate the dimensions of empowerment in Iran. Besides, personality characteristics, mental, social, cultural and individual backgrounds, individual disparities and psychological states while answering the questionnaire were amongst unmanageable variables in this study. On the other hand, since data was collected by self-report method, it may not reflect the relationship between variables in a realistic fashion.
Conclusion
The critical roles of medical emergency centers in maintaining and improving public health along with rapid changes in healthcare needs of society, necessitates that emergency service providers update their abilities on a regular basis. Thus, it is recommended that the authorities pay more attention towards the employees’ abilities while assigning responsibilities to them, and increase their efforts along with proper planning to create a favourable atmosphere of empowerment.
* One-way ANOVA test was used to calculate the p-value
[1]. Wagner JI, Cummings G, Smith DL, Olson J, Anderson L, Warren S, The relationship between structural empowerment and psychological empowerment for nurses: a systematic review Journal of Nursing Management 2010 18(4):448-62.10.1111/j.1365-2834.2010.01088.x20609049 [Google Scholar] [CrossRef] [PubMed]
[2]. Seibert SE, Wang G, Courtright SH, Antecedents and consequences of psychological and team empowerment in organizations: a meta-analytic review Journal of Applied Psychology 2011 96(5):981-1003.10.1037/a002267621443317 [Google Scholar] [CrossRef] [PubMed]
[3]. Fernandez S, Moldogaziev T, Employee empowerment, employee attitudes, and performance: Testing a causal model Public Administration Review 2013 73(3):490-506.10.1111/puar.12049 [Google Scholar] [CrossRef]
[4]. Nishii LH, Lepak DP, Schneider B, Employee attributions of the “why” of HR practices: Their effects on employee attitudes and behaviors, and customer satisfaction Personnel Psychology 2008 61(3):503-45.10.1111/j.1744-6570.2008.00121.x [Google Scholar] [CrossRef]
[5]. Fernandez S, Moldogaziev T, Using employee empowerment to encourage innovative behavior in the public sector Journal of Public Administration Research and Theory 2012 23(1):155-87.10.1093/jopart/mus008 [Google Scholar] [CrossRef]
[6]. Kim SY, Fernandez S, Employee empowerment and turnover intention in the US federal bureaucracy The American Review of Public Administration 2017 47(1):04-22.10.1177/0275074015583712 [Google Scholar] [CrossRef]
[7]. Patterson PD, Suffoletto BP, Kupas DF, Weaver MD, Hostler D, Sleep quality and fatigue among prehospital providers Prehospital Emergency Care 2010 14(2):187-93.10.3109/1090312090352497120199233 [Google Scholar] [CrossRef] [PubMed]
[8]. Patterson PD, Huang DT, Fairbanks RJ, Simeone S, Weaver M, Wang HE, Variation in emergency medical services workplace safety culture Prehospital Emergency Care 2010 14(4):448-60.10.3109/10903127.2010.49790020809688 [Google Scholar] [CrossRef] [PubMed]
[9]. Heidari M, Shahbazi S, Effect of training problem-solving skill on decision-making and critical thinking of personnel at medical emergencies International Journal of Critical Illness and Injury Science 2016 6(4):182-87.10.4103/2229-5151.19544528149823 [Google Scholar] [CrossRef] [PubMed]
[10]. Vegian CFL, Monteiro MI, Living and working conditions of the professionals of the a Mobile Emergency Service Revista Latino-americana de Enfermagem 2011 19(4):1018-24.10.1590/S0104-1169201100040002221876956 [Google Scholar] [CrossRef] [PubMed]
[11]. Heidari M, Ebrahimi P, Examining the relationship between critical-thinking skills and decision-making ability of emergency medicine students Indian Journal of Critical Care Medicine 2016 20(10):581-86.10.4103/0972-5229.19204527829713 [Google Scholar] [CrossRef] [PubMed]
[12]. Ghaniyoun A, Shakeri K, Heidari M, The association of psychological empowerment and job burnout in operational staff of Tehran emergency center Indian Journal of Critical Care Medicine 2017 21(9):563-67.10.4103/ijccm.IJCCM_56_1728970654 [Google Scholar] [CrossRef] [PubMed]
[13]. Essex B, Scott LB, Chronic stress andassociated coping strategies among volunteer ems personnel Prehospital Emergency Care 2008 12(1):69-75.10.1080/1090312070170795518189181 [Google Scholar] [CrossRef] [PubMed]
[14]. Young-Ritchie C, Laschinger HS, Wong C, The effects of emotionally intelligent leadership behaviour on emergency staff nurses’ workplace empowerment and organizational commitment Nursing Leadership 2009 22(1):70-85.10.12927/cjnl.2009.2061419289914 [Google Scholar] [CrossRef] [PubMed]
[15]. Spreitzer GM, An empirical test of a comprehensive model of intrapersonal empowerment in the workplace American Journal of Community Psychology 1995 23(5):601-29.10.1007/BF025069848851342 [Google Scholar] [CrossRef] [PubMed]
[16]. Spreitzer GM, Psychological empowerment in the workplace: Dimensions, measurement, and validation Academy of Management Journal 1995 38(5):11442-65.10.5465/256865 [Google Scholar] [CrossRef]
[17]. Eskandari F, Pazargadi M, Zagheri Tafreshi M, Rabie Siahkali S, Shoghli AR, Relationship between psychological empowerment with affective commitment among nurses in Zanjan, 2010 Preventive Care in Nursing & Midwifery Journal 2014 3(2):47-60.Available from:http://zums.ac.ir/nmcjournal/files/site1/user_files_eafc2e/fereidoun-A-10-124-1-425e75c.pdf [Google Scholar]
[18]. Knol J, Van Linge R, Innovative behaviour: The effect of structural and psychological empowerment on nurses Journal of Advanced Nursing 2009 65(2):359-70.10.1111/j.1365-2648.2008.04876.x19191936 [Google Scholar] [CrossRef] [PubMed]
[19]. Flesner MK, Rantz MJ, Mutual empowerment and respect: Effect on nursing home quality of care Journal of Nursing Care Quality 2004 19(3):193-96.10.1097/00001786-200407000-00004 [Google Scholar] [CrossRef]
[20]. Abedsaeedi Z, Mozafari M, Pazargadi M, Alavi MH, Status of employee empowerment in EMS providers in Iran Journal of Ilam University of Medical Sciences 2010 18(2):44-54. [Google Scholar]
[21]. Zhang X, Bartol KM, Linking empowering leadership and employee creativity: The influence of psychological empowerment, intrinsic motivation, and creative process engagement Academy of Management Journal 2010 53(1):107-28.10.5465/amj.2010.48037118 [Google Scholar] [CrossRef]
[22]. Nasiripour AA, Nave Ebrahim A, Tabibi SJ, Ebraze A, Izadi A, Study of Psychological Empowerment in Hospitals of Qom Province, Iran Qom Univ Med Sci J 2013 7(4):56-62. [Google Scholar]
[23]. Spence Laschinger HK, Finegan J, Shamian J, The impact of workplace empowerment, organizational trust on staff nurses’ work satisfaction and organizational commitment Advances in Health Care Management 2002 BingleyEmerald Group Publishing Limited10.1097/00004010-200107000-00002 [Google Scholar] [CrossRef]
[24]. Laschinger HKS, Finegan J, Shamian J, Promoting nurses’ health: Effect of empowerment on job strain and work satisfaction Nursing Economics 2001 19(2):42-52. [Google Scholar]
[25]. Macey WH, Schneider B, The meaning of employee engagement Industrial and Organizational Psychology 2008 1(1):3-30.10.1111/j.1754-9434.2007.0002.x [Google Scholar] [CrossRef]