کاوش بی‌‌قدرتی شغلی پرستاران

پژوهش حاضر دربارۀ فرایند شکل‌گیری بی‌‌قدرتی شغلی بین پرستاران بیمارستان‌‌های دولتی شهر یزد بررسی می‌کند. با استفاده از رویکرد کیفی و روش نظریۀ زمینه‌‌ای و با نمونه‌‌گیری نظری و هدفمند، 20 نفر از پرستاران بیمارستان‌‌های دولتی شهر یزد انتخاب شدند و با آنها مصاحبه‌های عمیقی انجام شد. فرایند نمونه‌‌گیری نظری تا مرحلۀ اشباع داده‌‌ها ادامه یافت. داده‌‌های گردآوری‌شده با استفاده از کدگذاری باز، محوری و گزینشی تحلیل و در قالب خط داستان (شامل 20 مقولۀ اصلی و 1 مقولۀ هسته)، الگوی پارادایمی و طرح‌‌وارۀ نظری ارائه شدند. نتایج نشان دادند بی‌‌قدرتی شغلی پرستاران به‌طور عمده به‌دنبال عواملی چون گفتار‌‌ قدرت ‌‌ مراقبت پزشکان، برساخت نارضایتی‌های مالی و وضعیت سیال بیماران برساخته می‌‌شود. پرستاران در مقابل بی‌قدرتی شغلی راهبرد‌‌های متفاوتی را برمی‌گزینند. کار عاطفی، درمان پراگماتیسمی و گفتمان اعتماد ازجمله این راهبردهاست که بین پرستاران فعال شده و با خود پیامد‌‌هایی مانند بی‌‌تفاوتی آموخته‌شده، حل گفتمانی اختلافات، هژمونی عواطف منفی و سبک‌‌های مراقبتی ترکیبی را داشته است. طرح‌وارۀ نظری این فرایند را ترسیم می‌کند.

Exploring Job Powerlessness of Nurses

Introduction The establishment of hospitals caused many people with different medical profession start working there. But, nurses always received less attention. When it comes to healthcare in hospitals, the community of nurses are taken into consideration. In most of medical institution, nursing department is one of the largest part and nursing staffs make up 40 to 60 percent of all human resources. In hierarchy of hospital class the community of nurses may get exposed to heavy pressure that refers to the system of the hospital, the patients, and their companies. This pressure may cause dissatisfaction. Besides the dissatisfaction, this pressure causes this community feel exhausted in hospitals. Many studies proved that job stress, dissatisfaction and burnout are common among nursing experts. For this reasons, among all hospital staffs, nurses need to be empowered to be effective for patients, doctors and the other health care experts along with for themselves. As usual, powerless nurses are those who are not effective in hierarchy of hospital class. Powerless nurses most of the time are dissatisfied about their career and also Prone to burnout. Regarding powerlessness problem among nurses, the present paper attempts to use a conceptual framework of sociology and an interpretive approach to describe the formation the processes of job powerlessness among nurses of Yazd governmental hospitals. In addition, in this paper, the question of how nurses’ powerlessness in Yazd governmental hospitals can be constructed will be answered.   Material & Methods In this paper, the qualitative methodology with its underlying theory is used. For conducting a substantial interview, the number of 20 nurses of Yazd governmental hospitals were selected. The interviews were continued until reaching theoretical saturation stage. After finishing every interview, the recordings were written and then analyzed by researcher. In analyzing process, linebyline analysis technique was utilized for open coding step. Along with the development of concepts and their abstraction, axial and selective coding steps were performed on the text. This paper considered ethical concepts such as legal harm prevention, informed consent, privacy, anonymity and confidentiality. Aliases are used to maintain the anonymity criterion, and for the sake of privacy, the participants’ private information was kept safe. By longterm contact with the research environment, continuous observation in the field of research, review, referral adequacy, rich description and approval of the participants, the reliability of research findings was confirmed. Also, the validity of the research was confirmed by observing the principles of interviewing, recording, and implementing the results of interviews.   Discussion of Results & Conclusions After analyzing the collected data, a core category entitled ‘hegemonic construction of job powerlessness’ was made up of 157 concepts, 33 subcategories, and 20 main categories. The results were presented in the form of story line, paradigm model and theoretical schema. The result showed that job powerlessness of nurses is basically originated from physician care, financial dissatisfaction, and the fluid situation of patients. In this situation, nurses choose different strategies against job powerlessness. Emotional work, pragmatic treatment, and trust discourse are the strategies that are common among nurses. Its implications are for some cases like learned apathy, conflict resolution, hegemony of negative emotions, and blended care styles. The overall result is that the social construction of job powerlessness is hegemonic in its acute state. This will include micro, mid and macro levels. In fact, hegemonic job powerlessness construction among nurses, at the micro level, is mentally created by nurses and is stabilized at the intermediate level by the hospital system organization and eventually is reproduced at the society level. This suggests that the construction of powerlessness constantly stems from the social context and thus can be altered by changing substrate, thus job powerlessness may increase or decrease.