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1 Copyright is owned by the Author of the thesis. Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only. The thesis may not be reproduced elsewhere without the permission of the Author.

2 VOLUME I A STUDY OF INDIVI DUAL AND ORGANI ZATIONAL VARIABLES IN RELATION TO CHARGE NURSE BEHAVIOUR A thesis presented in partial ful filment of the requirements for the degree of Doctor of Ph ilosophy at Massey Un iversity Nancy J. Kinross 1981

3 i ACKNOWLEDGEMENTS This study could never have been underta ken wi thout the cooperati on of the nurse administrators and charge nurses from the two hospitals concerned. These people gave freely of their time and knowl edge in an effort to assist the analysis of the processes underlying th eir own behaviour and the process of change. A number of people assisted wi th th e analysis of the results and the producti on of th is th es is. Special menti on should be made of Or Ken McFarl and wi'thout whom th is study would not have been compl eted; Professor George Shouksmi th who gave val uable advice; Ms Cathy Smi th who assisted with the stati stical analysis of the data; Or Andrew Trl in and Ms Margaret Idour who assi sted wi th th e proof reading and Ms Gai l Tyson who spent many hours ty ping the final copy. Final ly, menti on should be made of the support and assistance given by fami ly, friends, students and fel low staff members during the long period of gestation that preceded the presentati on of th is dissertati on.

4 i i TABLE OF CONTENTS Page ACKNOWLEDGEMENTS TABLE OF CONTENTS LIST OF TABLES LIST OF FIGURES ABSTRACT i i i iv vii viii PREAMBLE SECT! ON ONE Towards a Research Paradigm CHAPTER 1 A Search for an Overal l Framework CHAPTER 2 Towards a Research Paradi gm : Aspects of the Hospital as an Organization CHAPTER 3 CHAPTER 4 Identifying Process Outcomes and their Related Predictor and Moderator Variables Further Moderating Factors Affecting Process Outcomes: The Fate of New Ideas for Nursing Organization and Practice CHAPTER 5 Change as a Modera tor Va riable CHAPTER 6 Normative-Educative Strategies for Changing the Behaviour of People in Organizations SECTION TWO The Research Paradigm CHAPTER 7 The Research Design CHAPTER 8 Methodology Used in the Study 133 CHAPTER 9 Procedure and Setting 171

5 i i i SECTION THREE The Appl ication of the Research Paradigm: An Empiri cal Study CHAPTER 10 A Basel ine Analysis of Charge Nurse J>eha"'o'- r 193 CHAPTER 11 The Interpretation and 242 'Discussion of the Basel ine Data SECTION FOUR A Further Appl ication of the Research Paradigm: A Propositional Extension CHAPTER 12 The Groups and the 264 Intervention : A Normative Educative Approach to Change CHAPTER 13 The Propositional Extension: 291 Presentation and Discussion of Results SECTION FIVE A Prescription for Change 309 CHAPTER 14 Impl ications and Conclusions 310 REFERENCES GLOSSARY APPENDICES Vol.2

6 iv LIST OF TABLES TABLE People and Thetr Environments Frequency Distribution Highest Level of General Education Achieved Frequency Distribution First Level Professional Education Achi eved Frequency Distribution Charge Nurse Wo rk Location Frequency Distribution of Nurse Admi nistrators to whom Charge Nurses are responsible Frequency Distribution of age ranges Average Inter-Judge Agreement and Composite Rel iabi lity Scores Variables Used in Data Analysis Percentage Distribution of Categories by Theme Comparison of the Distribution of Categories by Rank Initi a l Factor Matrix S Major Loadings of Variables : Cl uster Major Loadings of Variabl es: Cl uster Major Loadings of Variables: Cl uster Major Loadings of Variabl es: Cl uster Major Loadings of Variables : Cluster Major Loadings of Variables: Cl uster Major Loadings of Variables: Cl uster Major Loadings of Variables: Cl uster

7 V TABLE Major Loadings of Variables : Cluster 9 Page Refer Appendix!1 Vol. II Intercorrel ations of Sel ected Predictor 219 and Criterion Variables Intercorrel ations of Selected Predictor (CPI) 224 Scores and Criterion Variables Intercorrel ations of Selected Predictor (POI ) 228 Scores and Criterion Variables Intercorrel ations of Selected Moderator and 235 Cri terion Variables 11.1 Highest Loading Variables in Cl usters Frequency Distribution of Group Members by 267 Work Location 12.2 Frequency Distribution of Group Members by 268 Time Spent in Present Work Location 12.3 Frequency Distribution of Group Members by 269 Level of General Education 12.4 Frequency Distributi on of Group Members by 270 Number of Postbasic Professional Qual i fications 12.5 Frequency Distribution of Group Members by Age Group Means for Representative CPI Variables Group Means for Representative POI Vari ables Group Means for Representative Organizational 275 Variables 12.9 Group Means for Representa tive Behavioural 276 Variables 13.1 The Distribution of Representative Variables 292 Examined in the Propositional Extension of the Study

8 Vi TABLE Page 13.2 Group A (before and after treatment, T 2 -T 1 ) Group B before and after treatment Group A 296 T -T 2 l 13.4 Group A before and after treatment and time 300 T 4 -T l 13.5 Groups A & C after treatment and time T 5 -T 4 306

9 vii LIST OF FIGURES FIGURE 1.1 Model of Rel ationships Between the Individual 12 and Social Systems 1.2 The Medical Care Process and its envi ronment Innovative Behaviour in Nursing Practice A Flow diagram of HMgerstrand1S Conceptual ization 53 of the innovation diffusion process 4.1 Hospital Nursing Services The Process of Infl uence and the Mechani sms 93 Underlying Each Stage 7.1 Innovative Behaviour in Nursing Practice: 131 a design model 9.1 Time Sequences for the Empi rical and Intervention 172 Sections of the Study 9.2 Structure of Nursing Service Organ ization, Beta 181 Hospi tal 9.3 Structure of Nursing Service Organ ization : 188 Del ta Hospital 13.1 Prepositional Extension : Sequence of Interventions 294 (time and training) and Analyses

10 vi ii ABSTRACT This study examines the impact of new ideas in the context of two hospital s. Concepts derived from systems theory have been used as a framework for the study which proposes that the innovative behaviour and characteri stics of charge nurses are modified by individual and organizational factors. This proposition is also examined over time and a training intervention. In the empirical section of this research, the statistical analysis yielded nine distinct cl usters of variables. Examination of these cl usters, and of the relationships between particular vari ables, led to the identifi cation of important combinations. In pa rticular, it was establ i shed that there is a positive rel ationship between measures of sel f assurance and interpersonal adequacy, as measured by the CPI, and judgements made by nurses in the ward Kardex. These judgements are infl uenced by the charge nurses ' perception of the organization. A positive relationship was also demonstrated between the general and speci fic measures of innovative behaviour, and the percept ion by charge nurses of the climate of the organization. In the propositi onal extension of the study, the effects of training and time on psychological characteri stics and innovative behaviour were quantitatively and quali tatively examined. The planned.training intervention devised for the study did resul t in significant shifts in psychological mindedness, social presence

11 ix and social i zation as measured by the CPl. The POI measures for inner directedness, existen tial ity and capacity for intimate contact showed si gni ficant differences over time, but not training. There was also evidence of innovative behaviour by charge nurses at both hospi tals over the seven month period of the study. It appears, therefore, that level s of general and specific innovativeness vary with the extent to which the organization is seen as facilitating or restrictive. Innovativeness is a rel ative concept, linked with social factors which infl uence perception. There is evidence in this study that training aimed at increasing knowl edge and sel f confi dence, can cause signifi cant changes in these social factors.

Copyright is owned by the Author of the thesis. Permission is given for a copy to be downloaded by an individual for the purpose of research and

Copyright is owned by the Author of the thesis. Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only. The thesis may not be reproduced elsewhere