الفهرس 
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Abstract
Nursing leadership has been described as the pivotal factor in the attainment of strategic goals by health care organizations. Leadership affects all facets of organizational operations. Transformational practices enhance the motivation, morale and performance of nurses through a variety of mechanisms. These include connecting the nurse’s sense of identity and self to the mission and the collective identity of the organization; being a role model for nurses that inspires them; challenging them to take greater ownership for their work and understanding the strengths and weaknesses of them. The leadership development program is a useful way for showing how the bedside nurses saw themselves as leaders; be empowered, have confidence in his/her abilities as a future leader and employ leadership practices.
Aim of the study:
Determine the impact of implementing a leadership development training program for staff nurses on structural empowerment, leadership self-efficacy, and clinical leadership practices.
The following hypotheses were proposed for this study
H1: Staff nurses undergoing a leadership development training program exhibit higher structure empowerment than before.
H2: Staff nurses undergoing a leadership development training program exhibit higher leadership self-efficacy than before.
H3: Staff nurses undergoing a leadership development training program exhibit higher clinical leadership practices than before.
Setting of the study:
This study was conducted in Inpatient Surgical Care Units at Alexandria Main University Hospital (N=15) namely; cardio thorax, neurology, head and neck, vascular, hepatic, neurosurgery, plastic, otorhinolaryngology, GIT, ophthalmology, colon and rectum, oncology, children surgery, urology (male and female) and children urology. The capacity of beds in surgical units was 756 beds.
Subjects of the study:
Total number of nurses who were working in surgical units at morning and afternoon shift (N=159) by using proportional allocation method, 25% of total number of nurses who are working in surgical units at morning and afternoon shift was selected randomly by simple random sample (N=40) were included in the study.
Tools of the study:
Three main tools were used in this study as follow:
Tool (1): Conditions of Work Effectiveness Questionnaire-II (CWEQ-II (
It was developed by Laschinger et al. (2001) and revised by Laschinger (2012) The CWEQ-II is a modification of the original Conditions of Work Effectiveness Questionnaire that was developed by Chandler (1986) to measure structural empowerment. It was adopted by the researcher. It consists of 19 items, which measure Kanter‘s six components of structural empowerment namely; opportunity, information, support, resources, formal power each of this dimension includes (3 items), and informal power (4 items). The responses were measured on a 5-point Likert scale ranging from (1) ‗a little‘ to (5) ‗a lot‘. A total empowerment score was calculated by summing the CWEQ-II six subscales (range 19-95). Higher score indicates high perception of structure empowerment. Score ranging (70-95) is described as high structure empowerment, (44-69) as moderate, and low structure empowerment score (19-43). (Appendix I(
Tool (2): Clinical Nurse Leader Self-Efficacy Scale (CNLSE)
It was developed by Gilmartin and Nokes (2015). It consists of 35 items designed to assess the nurse‘s confidence in performance of each of the 9 practice competencies of the clinical nurse leader (CNL) namely: population-based care (9 items), care planning (6 items), unit-based leadership (4 items), managing financial resources (6 items), team management (2 items), continuing education (2 items), mobilizing others (3items), professional leadership (1 items), and mentoring (2 items). The response was measured on a 5-point Likert scale ranging from (1) ‗not at all confident‘ to (5) ‗extremely confident‘. The overall score level ranging (35-175). Higher score on the instrument (129-175) implies greater self-efficacious in performance of leader practice competence, moderate score on the instrument (82-128) reveals moderate self-efficacious in performance of leader practice competence, lower score on the instrument (35-81) indicate lower self-efficacious in performance of leader practice competence. (Appendix I(
Tool (3): Clinical Leadership Observation Scale
It was developed by Kouzes and Posner (2012b) and was adopted by the researcher to assess clinical leadership of staff nurses aligning with Kouzes and Posner (2007). It consists of 30 items measuring leadership five practices namely; challenge the process, establish a shared vision, enable others to act, model the way, and encourage the heart; each dimension composed of (6 items). For purpose of ease response the scale was adapted from ten-point Likert scale to five -point Likert scale ranging from ”1” almost never to ”5” almost always. The overall score range from (30-150). Higher score on the instrument (110-150), moderate score on the instrument (70-109), lower score on the instrument (30-69). Score in the upper range implies greater leadership practices behavior. Whereas, score in the lower range implies lower leadership practices behavior. (Appendix I(
In addition, demographic characteristics data sheet was developed by the researcher; and included questions related to gender, age, educational qualification, working unit, years of units and nursing experience. (Appendix I(
Method
Tools (1& 2) translated into Arabic, and tested for their content validity by a panel of five experts in the field of the study and the necessary modifications were done based on their comments on translation. They were (two professor of nursing administration, one assistant professor of nursing education, one professor of gerontology, and one professors of medical and surgical nursing).
- Tool (3) clinical leadership observation scale was tested for its validity.
- Tools were tested for their reliability. The internal consistency reliability was assessed using Cronbach’s alpha coefficient. Reliability of tool (1) was= 0.81; too l (2) was= 0.77; tool (3) was= 0.88. That proved the tools were strongly reliable.
Data collection
Study was implemented through the following three phases for 5 months:
I. Exploratory phase from :( 27-12-2020 to 26-1-2021)
- Data collection was conducted by the researcher pre –program implementation through two methods:
(a) Self-administered questionnaire namely: Conditions of Work Effectiveness Questionnaire-II (CWEQ-II) tool (1), Clinical Nurse Leader Self-Efficacy Scale (CNLSES) tool (2) that was hand delivered to the study subjects at the study setting to assess nurse’s perceptions of structure empowerment and leadership self-efficacy .
)b) Continous observation was undertaken by the researcher using tool (3) Clinical Leadership Observation Scale for 40 staff nurses 6 working days per week , 2 hours per day for each nurse (12 hours/week for each nurse) to collect data concerning clinical leadership practices using the observation sheet.
II. Development and implementation of leadership training program: (from 2/2 to 26/2/2021)
C. Development of the program
1. Based on the result of the exploratory phase and the review of related literature (Hawkins & Thornton, 2002; Kouzes & Posner, 2005; Kouzes & Posner, 2012b; Oliver, 2006), the training program was developed, as well as teaching sessions and time schedule. (Appendix IV, V,VI)
2. Nurses were classified into two groups based on their working days. The program was conducted for 6 working days/ week for six hour per day for each group .The training program had a total of 72 hours training for the two groups.
3. The training program was implemented twice one working week for each group and for six hours / day.
D. Implementation of training program
1. Before the conduction of training program for nurses, needs assessment questionnaire was distributed to bedside staff nurses to collect data related to their previous training and their desires for leadership development training program. (Appendix II(
2. A knowledge test (pre- test) was administered to bedside staff nurses to collect data related to their level of knowledge. It consists of questions related to the five leadership practices, as follows: (concept of leadership and leader, the importance of leadership, the principles of leadership, the differences between manager and leader; the element of professional practice …etc.) the test was completed in 15 minutes. (Appendix III(
3. The training program was implemented for bedside staff nurses at the studied hospital, included general and specific objectives, relevant content, educational methods and evaluation technique.
- Content of the program was developed by the researcher based on thorough review of literature (Hawkins & Thornton, 2002; Kouzes & Posner, 2005; Kouzes & Posner, 2012b; Oliver, 2006) and included: General introduction (concept of leadership, difference between leader and manger, importance of leadership, principles of leadership, and element of professional practice)
Also, the five leadership practices: (1) Model the way (Goal setting, Action plan, and Decision making); (2) Inspire a shared vision (vision , mission, and communication skills); (3) Challenging the process (problem solving, innovation, change and risk taking); (4) Enabling others to act (team building and teamwork, emotional intelligence, coaching and collaboration ); and finally (5) Encouraging the heart (setting priorities, time management, motivation and creativity)
- The following suitable educational methods was utilized such as: interactive lectures, discussions, brainstorming, case studies, group work and exercise; while computer-based resources (PowerPoint presentations), visual aids (flip charts) and printed materials (handouts) was used as teaching media and instructional resources.
III. Evaluation of the training program (27/2 to 28/4/2021)
Evaluation of the program was carried out immediately after program implementation using the following steps:
- Participants’ reaction questionnaire: the structured form of questionnaire that including questions to measure strong and weak points related to program implementation, such as: objectives, time period, content, time schedule, of the program and methods of teaching used…etc.). It was distributed to nurses immediately after the program implementation to reveal their reactions to the benefits gained from the program. The questionnaire was explained regarding how to be answered. Nurses were given enough time to answer the questions (15 minutes). (Appendix VII)
- The knowledge test (post-test), which was used at the beginning of the program, was applied again to bedside staff nurses at the end of the program; to evaluate the gained knowledge in comparison with the pre-test .
- Self-administrated questionnaire using tools (1,2) of (the Conditions of Work Effectiveness Questionnaire-II, Clinical Nurse Leader Self-Efficacy Scale (CNLSES) that were used in the exploratory phase of the study, were used immediately at the end of the program and after 2 months later from program implementation to reveal the changes in staff nurses’ perceptions of structure empowerment and leadership self-efficacy .
- Observation, which undertaken by the researcher using tool (3) clinical leadership observation scale was used immediately at the end of the program and after 2 months later from program implementation to assess changes in nurse’s behavior regarding leadership practices.
The following were the main results of the present study:
There was a highly significant improvement of overall structural empowerment &its dimensions, leadership self efficacy&its dimensions as well as clinical leadership practices & its dimensions in the three phases of evaluation (before, immediately after and after 2month of program implementation)
The program had moderate effect on structural empowerment and leadership self-efficacy and large effect on both clinical leadership practices &leadership knowledge There was a highly positive significant correlation between leadership self-efficacy and structural empowerment and between clinical leadership practices and structural empowerment, leadership self-efficacy immediately after program implementation.
Recommendations were given based on the results of the present study to prepare future staff nurse leader of the second generation through; establish and organizing leadership training programs for staff nurses related to modern methods of problem solving and critical thinking, Overcome any obstacles and problems that may face them during continuing their education as high financial cost and lack of coordination between work time and educational time and shortage of nursing staff, create a conducive learning environment and more opportunities for nurses to be able to access leadership development resources through group discussion, library, periodic meetings and workshops, directors of nursing technical institute should teach the concepts of leadership competencies, empowerment and clinical leadership in the basic nursing curriculum for undergraduate students, staff nurses must attain training programs that focus on leadership skills such as communication skills, decision making skills and conflict resolution skills.