الفهرس 
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Abstract
Nowadays, autonomy is required to clarify and motivate the nursing profession in quickly varying health care environments. Also, the achievement of a higher level of autonomy by the nurses can provide a higher value and social recognition regarding this professional’s work and role. Professional nursing practice was developed through autonomy, professional relationships between nurses and physicians, control over the professional practice environment, and organizational support which contribute to a better quality of care offered to patients in in-patient services, greater nurses’ satisfaction, reduced nurses’ turnover, lower patients’ mortality rates, and increase organizational commitment.
Aim of the study
The study aims to determine staff nurses’ perspective of professional nursing autonomy, and organizational support in all general medical-surgical inpatient care units at Damanhour National Medical Institute.
Setting
This study was carried out in all general medical-surgical in-patient care units (n=11) at Damanhour National Medical Institute. Medical units (n=4) include: medical, hepatic, kidney, and hematemesis units. Surgical units (n=7) include: neurosurgical, orthopedic, urological, and surgery “A, B, C, D” units.
Subjects
The subjects of the study include all staff nurses in all general medical-surgical in-patient care units at Damanhour National Medical Institute (n=131) who were available at the previously mentioned units at the time of data collection. They were distributed in the medical units (n=52): general medical unit (n=15), hepatic unit (n=12), kidney unit (n=11), and hematemesis unit (n=14). They were distributed in the surgical units (n=79): neurosurgical unit (n=8), orthopedic unit (n=16), urological unit (n=11), and surgical units “A, B, C, D” (n=44).
Two staff nurses were in a sick leave at the time of data collection.
Tools of the study
Two tools were used in this study:
Tool I: Professional Nursing Autonomy Scale.
It was developed by the researcher based on the review of literature to determine
staff nurses’ perspective of professional nursing autonomy. It consists of 45 sub-items grouped under two main items namely: structural autonomy (n=35) and attitudinal autonomy (n=10). Structural autonomy consists of three items namely: nursing practice environment (n=14), patient care management (n=11), and educational background of staff nurses (n=10).
Responses of staff nurses were measured by four point-likert scale ranged from 4 (Very likely happen) to 1 (Very unlikely happen). The scoring system of professional nursing autonomy was categorized as high professional nursing autonomy (135-180 score), average professional nursing autonomy (90-134 score), and low professional nursing autonomy (45-89 score).
The scoring system of structural autonomy was categorized as high structural autonomy (105-140 score), average structural autonomy (70-104 score), and low structural autonomy (35-69 score). The scoring system of attitudinal autonomy was categorized as high attitudinal autonomy (30-40 score), average attitudinal autonomy (20-29 score), and low attitudinal autonomy (10-19 score).
Tool II: Organizational Support Scale.
It was developed by the researcher based on the review of literature to determine staff nurses’ perspective of organizational support. It consists of 45 sub-items grouped under three main items namely: supervisor support (n=19), fairness (n=14), and job conditions (n=12).
Responses of staff nurses were measured by five point-likert scale ranged from 5 (Strongly agree) to 1 (strongly disagree). The scoring system of organizational support was categorized as high organizational support (165-225 score), average organizational support (105-164 score), and low organizational support (45-104 score).
The scoring system of supervisor support was categorized as high supervisor support (70-95 score), average supervisor support (44-69 score), and low supervisor support (19-43 score). The scoring system of fairness was categorized as high fairness (52-70 score), average fairness (33-51 score), and low fairness (14-32 score). While, the scoring system of job conditions was categorized as good job conditions (44-60 score), average job conditions (28-43 score), and weak job conditions (12-27 score).
In addition, a socio-demographic and professional characteristics questionnaire was developed by the researcher related to staff nurses such as age, educational qualifications, name of unit, years of experience in nursing, and in the nursing unit.
Method
The two tools were translated into Arabic by the researcher and were tested for its content validity and translation by five experts in the field of the study.
Ethical consideration: an oral informed consent was obtained from the subjects of the study, privacy of the study subjects was maintained, and confidentiality was assured in the study.
A pilot study was conducted on staff nurses (n=100) working in general medical-surgical in-patient care units at Kafr Al-Dawar General Hospital after obtaining an official permission to ensure the clarity and feasibility of the tools, identify obstacles that may be encountered during data collection and estimate the time needed to fill the questionnaires.
Convergent validity was assessed using confirmatory factor analysis which prone dimensionality of the tools with model fit for test the quality of the tool domains definitions, and whether the questions assess single underline factor or construct.
Divergent validity was assessed using independent samples t-test which indicated that there was highly significant difference between the highest and the lowest quarter of the sample (Q4, Q1).
The questionnaires were tested for their reliability using cronbach’s alpha co-efficient test. The result proved to be reliable.
Data were collected from the staff nurses through distribution of questionnaire to them at the work setting using the previously mentioned tools. Instructions needed were given before the distribution of the questionnaire. The questionnaire was completed in the presence of the researcher to ensure the objectivity of staff nurses’ responses, non-contamination of their opinions, and to check that all items were answered. Answering the questionnaire took about 20-30 minutes. Six to seven staff nurses answered daily. It took a period of three weeks from 2 / 7 / 2016 to 23/ 7 / 2016.
After data were collected it was revised, coded and fed to statistical software IBM SPSS version 20.
The main results of the present study were as follows:
The highest total mean score percent of staff nurses’ perspective of professional nursing autonomy was related to attitudinal autonomy (71.2±12.4). While, the lowest total mean score percent was related to structural autonomy (68.6±9.2).
Regarding structural autonomy, the highest mean score percent was related to patient care management (77.6±11.7). While, the lowest mean score percent was related to nursing practice environment (56.5±11.8).
More than half of staff nurses had average level of professional nursing autonomy.
The highest mean score percent of staff nurses’ perspective of organizational support was related to supervisor support (68.3±13.2). While, the lowest mean score percent was related to job conditions (58.7±16.1).
More than two-third of staff nurses had perspective that organizational support level was average.
There are no statistically significant differences were found between demographic, professional characteristics of staff nurses and their perspective of professional nursing autonomy and organizational support.
There is a significant positive intermediate correlation between professional nursing autonomy and organizational support.
Based on the findings of the present study, the following recommendations are suggested.
D. For hospital administration:
8. Allow staff nurses to be involved in the major organizational decisions and committees such as: quality, infection control, environment, and training committees.
9. Support staff nurses for continuing education to strengthen their professional self-concept and professional nursing autonomy.
10. Encourage staff nurses to participate in and apply the results of research projects through the co-operation between the faculty of nursing and the hospital.
11. Build autonomy in staff nurses by providing them with more authorities and responsibilities to be able to provide care for patients with complex health care needs, to improve nurses’ image, and to maintain nursing professionalism.
12. Create a supportive work climate between supervisors and staff nurses which is based on trust and respect.
13. Develop staff development programs for head nurses to learn how to integrate staff nurses in decision-making and to deal effectively with new ideas in order to promote a supportive organizational climate as well as work climate.
14. Develop work group discussions on principles and basics of organizational fairness.
E. For head nurses:
1. Be role model in practicing professional nursing autonomy.
2. Encourage staff nurses to suggest new and innovative ideas about patient care and try to apply them in the work unit.
3. Provide staff nurses with continuing feedback about their performance and plan for training programs to improve their skills and performance to be able to exercise professional nursing autonomy.
4. Listen for work problems and try to solve them to help staff nurses feel comfort at work.
5. Assign duties and responsibilities among staff nurses according to their capabilities.
6. Conduct daily nurses’ conferences with staff nurses after daily work concerning patients care.
F. For staff nurses:
4. Follow hospital’ policies, rules, and regulations for guidance and protection of them from mistakes.
1. update their knowledge by continuous reading about health care problems, attending training programs, and asking questions to head nurses in order to be able to practice autonomously.
2. Communicate openly with the head nurses to discuss work problems and the ways of improvement of nursing care in the periodic meetings.
Future research studies should be conducted to:
Identify factors that affect staff nurses’ perspective of professional nursing autonomy and organizational support.
Assess the impact of managers’ leadership style on staff nurses’ perspective of professional nursing autonomy.