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Content and factor validation of the Sieloff-King-Friend Assessment of Group Empowerment within Educational Organizations
Nurse Education Today 42 (2016) 78–85
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Content and factor validation of the Sieloff-King-Friend Assessment of Group Empowerment within Educational Organizations Mary Louanne Friend a,⁎, Christian Leibold Sieloff b, Shannon Murphy a, James Leeper c a b c
Capstone College of Nursing, Box 870358, Tuscaloosa, AL 35487-0358, USA Montana State University, Bozeman College of Nursing, Billings Campus, Box 574, Billings, MT 59101, USA The University of Alabama, College of Community Health Sciences, Department of Community & Rural Medicine Box, 870327 Tuscaloosa, AL, USA
a r t i c l e
i n f o
Article history: Received 8 July 2015 Received in revised form 18 January 2016 Accepted 6 April 2016 Available online xxxx Keywords: Nursing faculty group empowerment Factor analysis Validity King's conceptual systems framework Sieloff-King Assessment of Group Empowerment within Organizations
a b s t r a c t Background and Purpose: Nursing education programs have responsibilities to their stakeholders to prepare graduates who can provide safe, effective patient centered care while leading health care changes. Empowered nurses have been associated with low nurse turnover and higher patient satisfaction; however, less is currently known about group empowerment in nursing education. In order to examine group empowerment in schools of nursing, the Sieloff-King Assessment of Group Empowerment in Organizations (SKAGEO©) was adapted and tested for content validity and confirmatory factor analysis. Methods/Results: The adapted instrument, the Sieloff-King-Friend Assessment of Group Empowerment within Educational Organizations (SKFAGEEO) was first reviewed by nurse experts who provided quantitative and qualitative data regarding each item. A total of 320 nurse deans and faculty comprised the final sample for the second order confirmatory 8 factor analysis. Findings revealed factor loadings ranging from .455 to .960.The overall fit of the propose model was Chi Square = 1383. 24, df = 566, p b .001; GFI = .786, RMSEA = 0.69. Conclusions: The study results indicated that the SKFAGEEO has acceptable psychometric properties. © 2016 Elsevier Ltd. All rights reserved.
1. Introduction
2. Background
There are few published studies examining faculty and administrator group empowerment and associated leadership competencies in baccalaureate nurse educators. Although nursing scholars have described a positive relationship between relationship-focused leadership and empowerment, nursing job satisfaction, intent to stay and positive patient outcomes (Murphy, 2005; Purdy et al., 2010; Cowden et al., 2011), less is currently known about nurse faculty empowerment. In efforts to acquire discipline-specific knowledge regarding group empowerment in baccalaureate nursing education, the Original Instrument (OI) was revised to measure faculty and administrator group empowerment in 79 American Association of Colleges of Nursing (AACN) member schools with baccalaureate and higher programs within the United States. The purpose of this paper is to report the results of content validity and confirmatory factor analysis for the Revised Instrument (RI) in a national study. (See Fig. 1.) (See Tables 1–6.)
2.1. Organizational Empowerment and Nursing Education Using Nonnursing Frameworks
⁎ Corresponding author at: The University of Alabama Capstone College of Nursing, Box 870358, Tuscaloosa, AL 35487, USA. E-mail addresses: [email protected] (M.L. Friend), [email protected] (C.L. Sieloff), [email protected] (S. Murphy), [email protected] (J. Leeper).
http://dx.doi.org/10.1016/j.nedt.2016.04.002 0260-6917/© 2016 Elsevier Ltd. All rights reserved.
Organizational empowerment and nursing education has been primarily described within non-nursing theoretical frameworks of research completed by Kanter (1977, 1993) and Spreitzer (1995). For example, Brancato (2007) examined the use of empowering teaching behaviors of baccalaureate nursing faculty, their psychological empowerment, and the relationships among their use of empowering teaching behaviors, their psychological empowerment, and selected demographic characteristics using Spreitzer's Psychological Empowerment Scale (1995). Baker et al. (2011) examined associate degree in nursing (ADN) educators' perceptions of empowerment, job satisfaction and relationships between them. These authors used Spreitzer's (1995) Psychological Empowerment Scale and the Conditions of Work. Effectiveness II (Laschinger et al., 2001) based on Kanter's theory of structural empowerment (1977, 1993). Likewise, Hebenstreit (2012) utilized Kanter's (1977, 1993) theory to examine relationships between structural empowerment and innovative behaviors in baccalaureate faculty. The conviction that nursing knowledge should be based upon discipline specific theory reinforced employing a mid-level nursing theory as the conceptual framework for the study.
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Fig. 1. Confirmatory Factor Analysis path diagram for eight factor model.
2.2. Importance of Unique Nursing Knowledge Regarding Empowerment within Nursing Education The significance of basing nursing knowledge upon conceptual frameworks of nursing has been well documented (Fawcett, 1999; Alligood and Tomey, 2010; Butts et al., 2012). A profession, by definition, has unique perspectives and subsequently, requires unique theoretical foundations in order to adequately examine their phenomena of interest (Fawcett, 1999). In order to support nursing's continuing status as a profession, unique knowledge is needed regarding faculty and administrators' empowerment in the academic setting. The theoretical foundation for this research, the theory of group empowerment within organizations (Sieloff, 2012) further fosters the development of this distinctive knowledge as this theory is a nursing theory of group empowerment, based within the nursing conceptual framework of Imogene King (1981). Whereas the predominant level of analyses in nursing empowerment research has been at the individual level, the concept of group empowerment is valuable since nurses work as teams. Likewise, the healthcare literature is replete with research related to effective teamwork and positive patient outcomes and patient safety (Lemieux-Charles and McGuire, 2006; Manser, 2009; Mazzocco et al., 2009).
2.3. The Theory of Group Empowerment Within Organizations The theory of group empowerment within organizations (Sieloff, 2012) was initially developed in 1995 (Sieloff, 1995) as the theory of
nursing departmental power. The theory resulted from a synthesis and reformulation of King's conceptual systems framework (King, 1981) and the strategic contingencies theory of power (SCTP) (Hickson et al., 1971) to explain nursing's observed lack of influence within health care organizations (Sieloff, 1995). King defined power as the ability to achieve goals (1981) while Hickson et al. (1971) addressed group power within organizations. The SCTP theorized that organizations consisted of interdependent sub-units, thereby focusing on group power as opposed to the traditional individual level of analysis. Sieloff reconceptualized the SCTP theory to be consistent with King's systems framework in order to develop concepts of organizational power that addressed the human context of nursing (Sieloff, 1995). Over time, selected concepts in the theory and instrument have undergone semantic revisions in response to changes in health care reorganization and nurses' negative perceptions of power. These revisions were considered to be theoretically sound (Sieloff, personal communication, October 9, 2015) and supported through a content validity study (Sieloff and Bularzik, 2011). For example, power was semantically relabeled as goal attainment as this term (goal attainment) was consistent with the theoretical framework. Goal attainment was then semantically relabeled as outcome attainment to better reflect the terminology being used within health care organizations (Sieloff, 2012). Sieloff subsequently theorized that groups, who are able to achieve outcomes, implement power [empower themselves] to “influence or control significant events in their lives” (Nyatanga and Dann, 2002, p. 235). As a result, outcome attainment capability was semantically
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Table 1 Definitions Sieloff King Theory of Group Empowerment©. Construct
Definition
Operational Definition
Empowerment capability
The group's capability to achieve outcomes and is seen as a positive resource that is available to all groups (Sieloff, 2012).
Empowerment capacity
Capacity of a group to achieve outcomes (Sieloff, 1999).
Controlling the effects Of environmental Forces (CEEF)
“Effectively managing the potential negative consequences that result from the effect of changing health care trends on the ability of an [organization] to achieve its goals” (Evans, [Sieloff],1989 as cited in Sieloff, 2007, p. 207). “The centrality of a nursing [group] within the communication network of a [nursing program]” (Sieloff, 1995, p. 57 as cited by Sieloff, 2007, p. 207) Any commodity that a nursing group can use for goal achievement (Maas, 1988, as cited in Sieloff, 2007, p. 207). “The degree to which the work of a nursing program is accomplished through the efforts of a nursing group” (Sieloff, 1995, p. 58 as cited in Sieloff, 2007, p. 207) The knowledge and skills of the group leader in relation to the achievement of group goals/outcomes (Sieloff, 1996). The knowledge and skill related to the giving of information from one group to another group (Sieloff, 1996). Achieving “events that are valued, wanted or desired” (King, 1981, p. 145) by a group. The perception and value regarding the achievement of goals/outcomes (Sieloff, 2007, p. 207)
Equal to the group's empowerment capacity interacting with four mediating variables or leadership competencies, measured by the total score on the instrument (Sieloff and Bularzik, 2011). Obtained by the total of four SKAGEO© subscale scores: a) controlling the effects of environmental forces, b) position, c) resources, and d) role. Measured by items number 4, 8, 9, 10 and 16 on the instrument.
Position (P)
Resources (RE) Role (RO)
Group leader's empowerment competency (GLOAC) Communication competency (CC) Goal/outcome competency (GOC) Empowerment perspective (OACP)
relabeled as equivalent to empowerment capability (actualized empowerment capacity) (Sieloff and Bularzik, 2011). These final semantic revisions resulted in the theory and instrument being semantically revised to the theory of group empowerment within organizations and the Original Instrument was relabeled (Sieloff, 2012). Sieloff defined empowerment as the ability of a group to achieve outcomes. However, empowerment also consisted of two sub-concepts: a) empowerment capacity [a group's potential to achieve outcomes], and b) the actualization of that capacity or empowerment capability. Sieloff conceptualized empowerment capacity as consisting of four factors: (a) controlling the effects of environmental forces, (b) position, (c) resources, and (d) role. In an effort to explain why some groups did not empower themselves in spite of the presence of these four factors, Sieloff identified four mediating factors that interacted with a group's empowerment capacity to result in the group's empowerment capability (empowerment) (1995). She identified these factors through observations, and labeled them as follows based on the results of a review of the literature: (a) communication competency, (b) goal/outcome competency, (c) group leaders' empowerment competency and (d) empowerment perspective. In summary, empowerment is defined as implementation of the capacity of a group to achieve its goals (Sieloff and Dunn, 2008) and is viewed as both a process and an outcome. Empowerment is conceptualized as an active process as opposed to the passing of authority and responsibility to individuals at lower levels in the organizational hierarchy (Bowen and Lawler, 1995). Theoretical assumptions are that
Measured by items number 6, 14, 32 and 33
Measured by items number 5, 15, 19, 20, 21, and 27 on the instrument. Measured by items number 12, 13, and 22 on the instrument.
Measured by items number 1,7,18 and 28 on the instrument Measured by items number 11, 26, and 29 on the instrument. Measured by items number 2, 17, 30 and 31 on the instrument. Measured by items number 3, 23, 25 and 34 on the instrument.
each nursing work team or group has an empowerment capacity and the ability to use that capacity (capability). 2.4. Description, Administration and Scoring of the Instrument The Original Instrument is a 36 item Likert scale instrument. The 20 items related to empowerment capacity measure a group's resources, capacity to adapt to environmental effects, and the group's capacity to achieve outcomes within larger organizations. The mediating factors (communication competency, empowerment perspective, goal/outcome competency, group leader's empowerment competency) mediate a group's ability to actualize its empowerment capacity. Group leaders and members can complete the instrument and their group empowerment capacity and capability are determined by comparing the group scores to a scoring grid. 2.4.1. Instrument Validity Psychometric analysis of the Original Instrument was initially confirmed (N = 334) with a Content Validity Index (CVI) of 92% and Cronbach's alpha of 0.92 (Sieloff, 1999). Subsequently, the instrument has demonstrated consistent reliability and validity worldwide (Sieloff, 1996, 1999; Sieloff and Bularzik, 2011; Bularzik et al., 2013; Viinikainen et al., 2015). Confirmatory factor analysis was completed to determine whether the relationships in the Original Instrument's first proposed eight factor model were compatible with data variance and covariance matrix.
Table 2 Content Expert Characteristics. Age
Gender
Years nursing education experience
Exact job position
Initial level of nursing education
Highest level of nursing education
Area of expertise
Major area of research/publications
72
F
40
Diploma
PhD nursing
Family/community health
Health promoting behavior
65 71 65 65 59
F F F F F
19 71 65 65 59
Assistant professor (retired March, 2012) Associate professor Clinical instructor Chairperson Associate dean Retired nurse executive
AD BSN BSN BSN BSN
PhD nursing Master's degree nursing PhD nursing PhD nursing DNP
Nursing administration Mental health nursing Adult and gerontology Leadership Critical care
Group empowerment Roy adaptions model Academic nursing centers leadership Caring theory and practice
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Table 3 Instrument Subscales with Original and Revised Items. Subscale
Original item
Revised item
Controlling the effects of environmental forces Communication competency
Client outcomes are directly linked to the group's interventions. The attainment of outcomes by the group is enhanced through communication with other organizational groups. The desired outcomes for the group provide for the development of the clinical competence of the group members.
Student outcomes and competencies are directly linked to the group's interventions. Empowerment is enhanced through communication with other organizational groups. The desired outcomes for the group provide for the development of the teaching effectiveness of the group members. The group leader understands how other groups utilize their group's empowerment. Empowerment is essential to assure that relationships within the organization are maintained to achieve the group's desired outcomes. Professional development programs adequately respond to the needs of the group members. The group coordinates the delivery of the curriculum.
Goal/outcome competency
Group leader's outcome attainment competency Empowerment perspective
Resources Role
The group leader understands how the attainment of outcomes is utilized by others within the organization. The attainment of outcomes is essential to assure that relationships within the organization are maintained to achieve the group's desired outcomes. Staff development programs adequately respond to the needs of the group members. The group coordinates the delivery of client care.
Note: Sample Items from the Sieloff-King Assessment of Group Power within Organizations, 1996.
Results indicated second order confirmatory factor loadings ranged from .43 to .89. The overall fit of the final respecified eight first order factor model with ten items deleted was χ2 (291, N = 350) = 504.70, p b .00; GFI = .90, CFI = .94, and RMSEA = .05 (Sieloff and Dunn, 2008, p.120). The authors concluded these findings supported the theory and instrument, and additional efforts to refine and revise the instrument should continue routinely with each new study (Sieloff and Dunn, 2008).
3. Methods 3.1. Design The research design was a concurrent nonexperimental survey design. The concurrent focus was consistent with the conceptualization of the variable (group empowerment) as a trait variable that could vary over time within the academic setting. The research was conducted in two phases: (a) content validity of the Revised Instrument, and (b) confirmatory factor analysis of the same instrument.
3.2. Protection of Human Subjects As a routine practice, the research was submitted to the institutional review board (IRB) for review, and approval was received prior to data collection. No risks to the participants or their psychological well-being were identified as the result of participating in the study. No discrimination occurred in the selection of the participants as a research assumption was that all nurses and nursing groups have both an empowerment capacity and capability. In addition, permission was obtained to revise the Original Instrument for use in the academic setting (Sieloff, personal communication, October 10, 2012).
3.3. Initial Revision of the Original Instrument In preparation for utilizing the Original Instrument within an educational site, this researcher modified the instrument by changing items reflecting clinical outcomes within an acute care setting to, instead, characterizing student outcomes within nursing education. In this context, the ‘group leader’ was the ‘chief administrative officer of the program’, the ‘nursing group’ was the ‘faculty’, and the ‘patients’ were the ‘nursing students’ as they are the recipients of the ‘nursing group's’/faculty's interventions. For example, changes included: (a) client care to curriculum, (b) clinical competence to teaching effectiveness and (c) client needs/acuity data to student numbers.
3.4. Content Validity Nursing education experts were recruited to evaluate each of the 36 items of the Revised Instrument for sufficiency, relevance, clarity, and adequacy of response items. In addition, participants were asked to provide suggested revisions for items deemed unclear or lacking representation of the concept of group empowerment. Three groups of experts were solicited for the content analysis: (a) nurse scholars familiar with Dr. King's work, (b) expert nurse educators and academic administrators and (c) scholars who were familiar with the body of research regarding nursing empowerment. The first group was contacted as these individuals would be familiar with the Original Instrument and be able to provide expertise in terms of revisions needed for the change in context from the clinical to the academic setting. The second group was contacted in order to provide context expertise in the review of the items. And, the third group was contacted in order to provide expertise in the content area of nursing empowerment. No assessment of the level of empowerment of the possible experts was done as it was assumed that all nurses and nursing groups have both an empowerment capacity and capability. An online request for assistance was sent to members of the King International Nursing Group (personal communication February 7, 2013), and was mailed electronically February 7, 2013. Using the snowball approach, additional experts were solicited. Seven experts met the above criteria (familiarity with the theory, expertise in the academic context and expertise in the content area of nursing empowerment). However, one of the seven was too ill to complete the survey by the designated due date. The resulting sample of six experts was deemed to be appropriate as at least five experts should be used when establishing content validity (Norwood, 2010). 3.4.1. Procedure After the content review experts were selected, they were provided with a list of behavioral objectives that had guided the instrument development, a definition of terms, and a list of instrument items (Waltz et al., 2010) using Qualtrics online software (Qualtrics, Provo, UT). The survey was distributed and completed within a time frame of 11 days. Participants were asked to rate each item on a Likert scale of one to four: a) not relevant, b) unable to assess relevance without item revision or item is in need of such revision that it would no longer be relevant, c) relevant but needs minor revision, and d) relevant (Lynn, 1986). In addition, participants were reminded that any reference to a group referenced to the group as a whole, within their organization, and not the specific individuals
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Table 4 Sample Characteristics. Frequency (%)
Gender Age
Highest nursing degree
Primary race/ethnic group
Academic rank
Type of academic organization
Number of baccalaureate students
Geographic area
Male Female 20–38 years old 39–50 years old 51–70 years old N70 years old Masters in nursing Masters in another discipline PhD in nursing PhD in another discipline DNP Asian Caucasian Hispanic Native American Other Instructor Assistant professor Associate professor Full professor Other Health science center Private State funded university Research university b200 201–300 301–400 401–500 501–600 601–700 N701 Mid-west North Atlantic South West
within that group. As a final point, participants were advised that the group leader for purposes of this study was the chief administrative officer for the school of nursing as defined by The Commission on Collegiate Nursing Education (CCNE).
Administrator(N = 79)
Faculty(N = 241)
2(2.0) 77(98) 0 5(6.3) 72(91) 3(2.7) 2(2.5) 0 43(54.4) 34(43.1)
17(7) 224(93) 34(14) 66(27.4) 114(47.3) 0 106(44) 3(1.2) 117(49) 15(7)
1(1.3) 75(94.9) 1(1.3)
2(.83) 231(95.8) 3(1.2) 1(.41) 4(1.7) 63(26) 106(44) 70(29) 2(.8) 0
1(1.3) 0 2(2.5) 19(24.1) 57(72.1) 1(1.3) 3(3.8) 43(54.4) 33(28) 1(1.3) 6(7.62) 17(21.5) 19(24) 19(24) 5(6.3) 6(7.7) 7(8.9) 55 (17) 64(20 155(49) 46(14)
3.4.2. Data Analysis Based upon the experts' reviews, the Content Validity Index for each item (I-CVI) was first calculated by identifying the number of experts who rated each item relevant (3 or 4) and then dividing that number
Table 5 Validity Testing of Subscales Faculty and Administrator Subscales. Subscale
CC CEEF GLOC GOC OACP P RE RO Spearman Split Half/Guttmann administrator Cronbach alpha
Correlation between forms Spearman Brown Coefficient Equal Length Guttmann Split Half Coefficient Uneven Length Spearman Split Half/Guttmann faculty
Correlation between forms Spearman Brown Coefficient Equal Length Guttmann Split Half Coefficient Uneven Length
Administrator (N = 79)
Faculty (N = 241)
Cronbach alpha
Cronbach alpha
.63 .91 .59 .74 .81 .71 .79 .87 Part 1 value(N = 18) .869 Part 2 value(N = 18) .846 .830 .907 .907 Part 1 value (N = 18) .922 Part 2 value (N = 18) .909 .878 .935 .935
.77 .90 .68 .79 .80 .81 .86 .88
Note: CC = communication competency, CEEF = controlling the effects of environmental forces, GOC = goals/outcomes competency, GLOAC = group leader's outcome attainment competency, OACP = outcome attainment perspective, P = position, RE = resources, RO = role.
M.L. Friend et al. / Nurse Education Today 42 (2016) 78–85
4.1. Procedure
Table 6 Model Fit Statistics SKAGPO and Adapted SKAGEO. SKAGPO RMSEA GFI χ2 df p
Adapted SKAGEO .06 .82 1360 586 p b .00
83
.069 .786 1383 566 p b .001
Note: SKAGPO = Sieloff-King Assessment of Group Power.
by the number of experts (Lynn, 1986). The I-CVI ranged from 0.67 to 1.00 for the 36 items of the Revised Instrument. When there are six or more judges, the I-CVI should be no lower than 0.78 and at least 0.83 in order to consider the item content valid (Lynn, 1986). Likewise, Polit and Beck reported CVI values of 0.78 with three or more judges can be considered evidence of good content validity (2006). As a result, three items were revised per expert's suggestions prior to use of the instrument. The content validity of the overall Revised Instrument (the S-CVI) was also calculated. This researcher added the number of I-CVIs and then divided by the number of items (S-CVI/Ave) (Polit and Beck, 2008). This value was calculated as being 0.971, greater than the recommended target of 0.90 (Polit and Beck, 2006). This number is also mathematically equal to the average congruency percentage which should be 0.90 (Waltz et al., 2010)
3.5. Qualitative Feedback Three content experts identified four of the 36 items as being unclear. After review, the researcher accepted the expert's recommendations to exclude the language attainment of outcomes and substitute the word empowerment. In addition, item number 27, addressing budgeting, was changed to “Budgeted positions for the groups are determined by student needs”. This modification addressed experts' concerns that the item did not adequately address clinical as well as well as non-clinical courses.
The study was approved by a university human subjects' committee/ institutional review board (IRB). Data collection occurred over a 12week period during two academic terms. A letter describing the study was sent to the administrator of each of the 320 eligible institutions. Once the participating administrators identified a contact person to distribute the surveys, a letter describing the study, along with a hyperlink to the survey was sent to be electronically forwarded to the faculty. Because surveys were sent electronically to participants, completing the questionnaire signified consent to be in the study. 4.2. Data Analysis — Psychometric Examination of the Revised Instrument Data analyses were conducted using Predictive Analytics Software (PASW), version 18.0, for descriptive, reliability, comparative, and correlation analyses (PASW Version 18.0. Chicago: SPSS Inc.). Psychometric evaluation of the instrument in this study was evaluated using Cronbach's alpha, Split-Half Method, Equal Length Spearman Brown Correction Formula. The exact sample size needed for a confirmatory factor analysis has not been identified. However, most agree that from three to 15 times the number of variables to not less than 200 participants is adequate (Stevens, 2012; Loehlin, 2004). The sample size for this study was 320 including surveys which were not used due to incomplete responses (surveys from 25 administrators and 62 faculty). The model tested had 45 observed variables, thereby meeting both of the above conditions. In order to verify the goodness of fit with this sample of nurse educators and administrators, factorial validity of the Revised Instrument was determined using AMOS software (Arbuckle, 2006). Eight first order factors, previously identified for the Original Instrument were used for the analysis (Sieloff and Dunn, 2008). Several indices of fit were utilized, including the root mean square error of approximation (RMSEA) and Goodness of Fit Indices (GFI). RMSEA expresses fit per degree of freedom of the model and ranges from 0 and 1, with smaller values indicating better fit. Acceptable RMSEA (b.08–.05) and acceptable GFI (N.95) were used for this study (Schumacker and Lomax, 2010). 5. Results
4. Confirmatory Factor Analysis 5.1. Model Fit Following the finalization of the Revised Instrument, the second phase of the research was begun to gather the data for the confirmatory factor analysis portion of the continuing psychometric examination of the Revised Instrument. The population for this study was approximately 15,282 administrators and faculty from 335 AACN member schools offering baccalaureate and higher degrees in the United States with 16 or more full-time faculty (Yan Li, personal communication, April 11, 2013). A minimum of 16 faculty was selected to accommodate schools that were smaller with fewer resources. Since, the response rate for this study was anticipated to be somewhere between 40 and 60%, and it was necessary for the school administrators to agree to participate in order to obtain faculty support, cover letters requesting participation in the project were electronically sent to all 335 deans of nursing. Of these emails sent, 15 deans were out of the office, or no longer in the dean position, reducing the sample size to three hundred twenty schools. The study sample involved 241 full-time faculty and 79 administrators who agreed to participate in the study from 79 colleges of nursing who were members of the American Association of Colleges of Nursing (AACN) and represented four geographic areas including southern, north-eastern, mid-western and the western United States. Although equal strata were desired, the final sample did not result in a geographically representative sample.
Second-order confirmatory eight factor analysis of the Revised Instrument was calculated using AMOS (Arbuckle, 2006). Factor loadings ranged from .455 to .960. The standardized regression weights for each latent construct were found to be sufficient except for one item that loaded with a negative loading of −0.38. This item [the attainment of outcomes is essential to assure that the desired outcomes of the organization, the group and the individual members with the group are consistent] had not been identified by experts as needing revision during the content validity study. Likewise, the alpha for the one scale associated with this question was greater than .70 in both administrator and faculty groups (0.81 and 0.80 respectively). The CFA was computed without this item, and the model fit was not affected after removing the item, nor was the overall fit improved. The overall fit of the measured model was compared to the CFA reported on the Original Instrument (Sieloff and Dunn, 2008). The current model findings suggested an acceptable fit with the data including GFI = .786, RMSEA = 0.69. A power analysis for these using guidelines in Schumacker and Lomax (2010) indicated 1.0. The statistical significance of each factor loading was also examined and all factor loadings were found to have a critical ratio (CR) greater than 1.96 except for question three which had a CR of −.648. Modification indices for the regression weights were also examined to identify cross-
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loadings and all regression weights are statistically significant except (OAP). However, when this item was omitted, the fit of the model did not improve. Suggestions for future research include qualitative analyses of the item to determine if the item is needed or to identify a new item that measures the construct more effectively. 6. Discussion This research has implications for many areas of nursing: practice, education, management and future research. In terms of practice, one should consider the practice to be within the academic setting with faculty acting as ‘nurses’ and the students as the nurses ‘clients’. By assessing the faculty group's empowerment, the faculty members can develop strategic plans to increase their group empowerment based on their scores on the instrument's items. By improving their group's empowerment, they will be able to improve their work environments and, subsequently, increase the job satisfaction and retention and recruitment of faculty members. 6.1. Implications for Education In terms of nursing education, faculty who are fully informed of their level of group empowerment may subsequently assist students to increase their own awareness of group empowerment both in the classroom and the practice setting. Through this increasing selfawareness, educators may be able to assist student groups to also gain understanding of the relevance of group empowerment to the safety and quality of patient care. Lastly, those nursing schools that facilitate faculty group empowerment may encourage others to choose academics and administrative positions as a viable career option, thereby strengthening the future of the profession. 6.2. Implications for Management Administrators who can measure group empowerment capacity and capability with one instrument may have the advantage as they recruit and preserve nurse faculty. The ability to measure and report group empowerment may also assist administrators to increase their visibility within their individual organizations by effectively capturing their capability to achieve outcomes. Ultimately leaders who value group empowerment may be better prepared to create and support academic environments where faculty can prepare advanced practice and baccalaureate prepared nurses who are themselves empowered team members. 6.3. Implications for Research A recommendation for future studies is to refine items on subscales communication competency, and goals/outcome competency that had low Cronbach alphas in the original study, precluding their use in the correlational analyses. In addition, future research should include open ended questions to gather valuable qualitative data. Additionally, although the findings of this study suggest faculty groups are empowered, further studies with larger more geographically diverse samples are warranted. Replicating the study in other countries would also strengthen the understanding of global group empowerment in nursing education. 7. Limitations Content validity is inherently biased since feedback from experts is subjective and participants were not asked to identify content that may have been missing from the instrument. The fact that all participants were from the United States may also create bias due to cultural values regarding empowerment. The low response rate of participating faculty from selected schools in this study sample is a limitation. This
may be attributed to the timing of data collection during the end of spring semester when faculty members are busy. Low response rates may also be a result of not having direct access to faculty. Faculty who felt less empowered may have been reluctant to participate as the survey was primarily distributed by administrators or their designated staff. Furthermore, as with faculty, less empowered administrators may have also been reluctant to participate. Incomplete responses prohibited analyzing surveys from 25 administrators and 62 faculty members. The sampling method also prohibits generalization since deans were recruited from a stratified list of schools using single staged sampling in order to increase faculty participation. 8. Conclusions In this study, content validity and confirmatory factor analysis was completed for the Revised Instrument, a revision of the Original Instrument adapted for use in nursing education. Content validity was sufficient (SCIV/Ave 0.971) and confirmatory factor analysis (CFA) suggested the adapted instrument and theoretical model had an adequate fit with the data. The analyses of reliability and validity demonstrated strong psychometric properties except for one item in subscale ‘empowerment perspective’ that may need further refinement in future studies. The ability to alleviate the global nursing shortage depends upon an ample supply of faculty who are satisfied with their jobs and who remain in nursing education. The Revised Instrument addresses both fiscal and physical resources, academic support services and leadership competencies associated with group empowerment. The capability to measure faculty group empowerment may facilitate the retention of current educators and the recruitment of additional faculty. Testing and verifying nursing theory by confirmatory factor analysis (CFA) is an important phase of obtaining discipline specific knowledge since CFA requires a strong conceptual foundation to guide the specification and evaluation of the factor model (Brown, 2015). The theoretical variables of the Sieloff King Theory of Group Empowerment were supported by the findings within this sample. This study increased the understanding of group empowerment within nursing education based upon a nursing theory and a single instrument incorporating multiple measures. Ongoing research should be completed to continue to further refine and revise the instrument. Likewise, using the instrument in nursing programs worldwide may also enable cross cultural efforts by educators and their leaders to identify and support empowered work environments. Leaders across the world have advocated for revised relevant nursing pedagogy where adult learning principles, seamless entry, and virtual learning are embraced. These efforts will ultimately require creative faculty and administrators who work in empowered environments. References Alligood, T., Tomey, A.N., 2010. Nursing Theorists and Their Work. Mosby Elsevier, Maryland Heights, MO. Arbuckle, J.L., 2006. Amos (Version 7.0) [Computer Program]. SPSS, Chicago. Baker, S.L., Fitzpatrick, J.J., Griffin, M.Q., 2011. Empowerment and job satisfaction in associate degree nurse educators. Nurs. Educ. Perspect. 32, 234–239. Bowen, D.E., Lawler, E.E., 1995. Empowering Service Employees. MIT press, Cambridge, MA. Brancato, V.C., 2007. Psychological empowerment and use of empowering teaching behaviors among baccalaureate nursing faculty. J. Nurs. Educ. 46 (12), 537–544. Brown, T.A., 2015. Confirmatory Factor Analysis for Applied Research. Guilford Publications, New York. Bularzik, A.M., Tullai-McGuinness, S.T., Sieloff, C.L., 2013. Nurse's perceptions of their group goal attainment capability and professional autonomy: a pilot study. J. Nurs. Manag. 21 (3), 581–590. Butts, J.B., Rich, K.L., Fawcett, J., 2012. The future of nursing: how important is disciplinespecific knowledge? A conversation with Jacqueline Fawcett. Nurs. Sci. Q. 25 (2), 151–154. Cowden, T., Cummings, G., Profetoo-Mcgrath, J., 2011. Leadership practices and staff nurses' intent to stay: a systematic review. J. Nurs. Manag. 19 (4), 461–477. Evans, Sieloff, C.L., 1989. Development of a departmental theory of power within Imogene King's framework: Unpublished manuscript.
M.L. Friend et al. / Nurse Education Today 42 (2016) 78–85 Fawcett, J., 1999. The state of nursing science: hallmarks of the 20th and 21st centuries. Nurs. Sci. Q. 12 (4), 311–315. Hebenstreit, J., 2012. Nurse educator perceptions of structural empowerment and innovative behavior. Nurs. Educ. Perspect. 33 (5), 297 [serial online]. September 2012. Accessed June 22, 2015. Hickson, D.J., Hinings, C.R., Lee, C.A., Schneck, R.E., Pennings, J.M., 1971. A strategic contingencies' theory of intraorganizational power. Adm. Sci. Q. 16, 216–229. Kanter, R.M., 1977. Men and Women of the Corporation. vol. 5049. Basic Books, New York. Kanter, R.M., 1993. Men and Women of the Corporation. second ed. Basic Books, New York. King, I.M., 1981. A Theory for Nursing: Systems, Concepts, Process. Wiley, New York. Laschinger, H.K.S., Finegan, J., Shamian, J., Wilk, P., 2001. Impact of structural and psychological empowerment on job strain in nursing work settings: expanding Kanter's model. J. Nurs. Adm. 31 (5), 260–272. Lemieux-Charles, L., McGuire, W.L., 2006. What do we know about health care team effectiveness? A review of the literature. Med. Care Res. Rev. 63 (3), 263–300. Loehlin, J.C., 2004. Latent variable models: An introduction to factor, path and structural analysis. 4th ed. Erlbaum, Mahwah, New Jersey. Lynn, J.R., 1986. Determination and quantification of content validity. Nurs. Res. 35, 382–385. Maas, M.L., 1988. A model of organizational power: analysis and significance to nursing. Res. Nurs. Health 11, 153–163. Manser, T., 2009. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol. Scand. 53 (2), 143–151. Mazzocco, K., Petitti, D.B., Fong, K.T., Bonacum, D., Brookey, J., Graham, S., Thomas, E.J., 2009. Surgical team behaviors and patient outcomes. Am. J. Surg. 197 (5), 678–685. Murphy, L., 2005. Transformational leadership: a cascading chain reaction. J. Nurs. Manag. 13 (2), 128–136. Norwood, S.L., 2010. Research Essentials: Foundations for Evidence-based Practice. Pearson, Boston, MA. Nyatanga, L., Dann, K.L., 2002. Empowerment in nursing: the role of philosophical and psychological factors. Nurs. Philos. 3, 234–239. Polit, D.F., Beck, C.T., 2006. The content validity index: are you sure you know what's being reported? Critique and recommendations. Res. Nurs. Health 29 (5), 489–497.
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Polit, D.F., Beck, C.T., 2008. Nursing Research: Generating and Assessing for Nursing Practice. eighth ed. Lippincott, Williams & Wilkins, Philadelphia. Purdy, N., Spence Laschinger, H.K., Finegan, J., Kerr, M., Olivera, F., 2010. Effects of work environments on nurse and patient outcomes. J. Nurs. Manag. 18 (8), 901–913. Schumacker, R.E., Lomax, R.G., 2010. A Beginner's Guide to Structural Equation Modeling. third ed. Routledge, New York. Sieloff, C.L., 1995. Development of a theory of departmental power. In: Frey, M.A., Sieloff (Eds.), Advancing King's Systems Framework and Theory of Nursing. SAGE Publications, Thousand Oaks, California, pp. 46–65. Sieloff, C.L., 1996. Development of an Instrument to Estimate the Actualized Power of a Nursing Department Unpublished dissertation Wayne State University, Detroit. Sieloff, C.L., 1999. Sieloff-King Assessment of Group Power within Organizations Unpublished research report Oakland University, Rochester, Michigan. Sieloff, C.L., 2007. The theory of group power within organizations — Evolving conceptualization within King's conceptual system. In: Sieloff, Frey, M.A. (Eds.), Middle Range Theory Development: Using King's Conceptual System. Springer Publishing Company, New York, pp. 196–214. Sieloff, C.L., 2012. Theory of group empowerment within organizations©. (Retrieved from) https://sites.google.com/site/theoryofnursinggrouppower. Sieloff, C.L., Bularzik, A.M., 2011. Group power through the lens of the century and beyond: further validation of the Sieloff–King Assessment of Group Power within Organizations. J. Nurs. Manag. 19, 1020–1027. Sieloff, C.L., Dunn, K., 2008. Factor validation of an instrument measuring group power. J. Nurs. Meas. 16 (2), 113–124. Spreitzer, G.M., 1995. Psychological empowerment in the workplace: dimensions, measurement and validation. Acad. Manag. J. 38, 1442–1465. Stevens, J.P., 2012. Applied Multivariate Statistics for the Social Sciences. fifth ed. Routledge, New York. Viinikainen, S., Asikainen, P., Sieloff, C., Helminen, M., Suominen, T., 2015. Is the first-line nursing managers' power congruent with that of the nursing group? Nordic J. Nurs. Res. 35 (1), 3–9. Waltz, C., Strickland, O.L., Lenz, E. (Eds.), 2010. Measurement in Nursing and Health Research. Springer Publishing Company, New York.
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
Content and factor validation of the Sieloff-King-Friend Assessment of Group Empowerment within Educational Organizations Mary Louanne Friend a,⁎, Christian Leibold Sieloff b, Shannon Murphy a, James Leeper c a b c
Capstone College of Nursing, Box 870358, Tuscaloosa, AL 35487-0358, USA Montana State University, Bozeman College of Nursing, Billings Campus, Box 574, Billings, MT 59101, USA The University of Alabama, College of Community Health Sciences, Department of Community & Rural Medicine Box, 870327 Tuscaloosa, AL, USA
a r t i c l e
i n f o
Article history: Received 8 July 2015 Received in revised form 18 January 2016 Accepted 6 April 2016 Available online xxxx Keywords: Nursing faculty group empowerment Factor analysis Validity King's conceptual systems framework Sieloff-King Assessment of Group Empowerment within Organizations
a b s t r a c t Background and Purpose: Nursing education programs have responsibilities to their stakeholders to prepare graduates who can provide safe, effective patient centered care while leading health care changes. Empowered nurses have been associated with low nurse turnover and higher patient satisfaction; however, less is currently known about group empowerment in nursing education. In order to examine group empowerment in schools of nursing, the Sieloff-King Assessment of Group Empowerment in Organizations (SKAGEO©) was adapted and tested for content validity and confirmatory factor analysis. Methods/Results: The adapted instrument, the Sieloff-King-Friend Assessment of Group Empowerment within Educational Organizations (SKFAGEEO) was first reviewed by nurse experts who provided quantitative and qualitative data regarding each item. A total of 320 nurse deans and faculty comprised the final sample for the second order confirmatory 8 factor analysis. Findings revealed factor loadings ranging from .455 to .960.The overall fit of the propose model was Chi Square = 1383. 24, df = 566, p b .001; GFI = .786, RMSEA = 0.69. Conclusions: The study results indicated that the SKFAGEEO has acceptable psychometric properties. © 2016 Elsevier Ltd. All rights reserved.
1. Introduction
2. Background
There are few published studies examining faculty and administrator group empowerment and associated leadership competencies in baccalaureate nurse educators. Although nursing scholars have described a positive relationship between relationship-focused leadership and empowerment, nursing job satisfaction, intent to stay and positive patient outcomes (Murphy, 2005; Purdy et al., 2010; Cowden et al., 2011), less is currently known about nurse faculty empowerment. In efforts to acquire discipline-specific knowledge regarding group empowerment in baccalaureate nursing education, the Original Instrument (OI) was revised to measure faculty and administrator group empowerment in 79 American Association of Colleges of Nursing (AACN) member schools with baccalaureate and higher programs within the United States. The purpose of this paper is to report the results of content validity and confirmatory factor analysis for the Revised Instrument (RI) in a national study. (See Fig. 1.) (See Tables 1–6.)
2.1. Organizational Empowerment and Nursing Education Using Nonnursing Frameworks
⁎ Corresponding author at: The University of Alabama Capstone College of Nursing, Box 870358, Tuscaloosa, AL 35487, USA. E-mail addresses: [email protected] (M.L. Friend), [email protected] (C.L. Sieloff), [email protected] (S. Murphy), [email protected] (J. Leeper).
http://dx.doi.org/10.1016/j.nedt.2016.04.002 0260-6917/© 2016 Elsevier Ltd. All rights reserved.
Organizational empowerment and nursing education has been primarily described within non-nursing theoretical frameworks of research completed by Kanter (1977, 1993) and Spreitzer (1995). For example, Brancato (2007) examined the use of empowering teaching behaviors of baccalaureate nursing faculty, their psychological empowerment, and the relationships among their use of empowering teaching behaviors, their psychological empowerment, and selected demographic characteristics using Spreitzer's Psychological Empowerment Scale (1995). Baker et al. (2011) examined associate degree in nursing (ADN) educators' perceptions of empowerment, job satisfaction and relationships between them. These authors used Spreitzer's (1995) Psychological Empowerment Scale and the Conditions of Work. Effectiveness II (Laschinger et al., 2001) based on Kanter's theory of structural empowerment (1977, 1993). Likewise, Hebenstreit (2012) utilized Kanter's (1977, 1993) theory to examine relationships between structural empowerment and innovative behaviors in baccalaureate faculty. The conviction that nursing knowledge should be based upon discipline specific theory reinforced employing a mid-level nursing theory as the conceptual framework for the study.
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Fig. 1. Confirmatory Factor Analysis path diagram for eight factor model.
2.2. Importance of Unique Nursing Knowledge Regarding Empowerment within Nursing Education The significance of basing nursing knowledge upon conceptual frameworks of nursing has been well documented (Fawcett, 1999; Alligood and Tomey, 2010; Butts et al., 2012). A profession, by definition, has unique perspectives and subsequently, requires unique theoretical foundations in order to adequately examine their phenomena of interest (Fawcett, 1999). In order to support nursing's continuing status as a profession, unique knowledge is needed regarding faculty and administrators' empowerment in the academic setting. The theoretical foundation for this research, the theory of group empowerment within organizations (Sieloff, 2012) further fosters the development of this distinctive knowledge as this theory is a nursing theory of group empowerment, based within the nursing conceptual framework of Imogene King (1981). Whereas the predominant level of analyses in nursing empowerment research has been at the individual level, the concept of group empowerment is valuable since nurses work as teams. Likewise, the healthcare literature is replete with research related to effective teamwork and positive patient outcomes and patient safety (Lemieux-Charles and McGuire, 2006; Manser, 2009; Mazzocco et al., 2009).
2.3. The Theory of Group Empowerment Within Organizations The theory of group empowerment within organizations (Sieloff, 2012) was initially developed in 1995 (Sieloff, 1995) as the theory of
nursing departmental power. The theory resulted from a synthesis and reformulation of King's conceptual systems framework (King, 1981) and the strategic contingencies theory of power (SCTP) (Hickson et al., 1971) to explain nursing's observed lack of influence within health care organizations (Sieloff, 1995). King defined power as the ability to achieve goals (1981) while Hickson et al. (1971) addressed group power within organizations. The SCTP theorized that organizations consisted of interdependent sub-units, thereby focusing on group power as opposed to the traditional individual level of analysis. Sieloff reconceptualized the SCTP theory to be consistent with King's systems framework in order to develop concepts of organizational power that addressed the human context of nursing (Sieloff, 1995). Over time, selected concepts in the theory and instrument have undergone semantic revisions in response to changes in health care reorganization and nurses' negative perceptions of power. These revisions were considered to be theoretically sound (Sieloff, personal communication, October 9, 2015) and supported through a content validity study (Sieloff and Bularzik, 2011). For example, power was semantically relabeled as goal attainment as this term (goal attainment) was consistent with the theoretical framework. Goal attainment was then semantically relabeled as outcome attainment to better reflect the terminology being used within health care organizations (Sieloff, 2012). Sieloff subsequently theorized that groups, who are able to achieve outcomes, implement power [empower themselves] to “influence or control significant events in their lives” (Nyatanga and Dann, 2002, p. 235). As a result, outcome attainment capability was semantically
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Table 1 Definitions Sieloff King Theory of Group Empowerment©. Construct
Definition
Operational Definition
Empowerment capability
The group's capability to achieve outcomes and is seen as a positive resource that is available to all groups (Sieloff, 2012).
Empowerment capacity
Capacity of a group to achieve outcomes (Sieloff, 1999).
Controlling the effects Of environmental Forces (CEEF)
“Effectively managing the potential negative consequences that result from the effect of changing health care trends on the ability of an [organization] to achieve its goals” (Evans, [Sieloff],1989 as cited in Sieloff, 2007, p. 207). “The centrality of a nursing [group] within the communication network of a [nursing program]” (Sieloff, 1995, p. 57 as cited by Sieloff, 2007, p. 207) Any commodity that a nursing group can use for goal achievement (Maas, 1988, as cited in Sieloff, 2007, p. 207). “The degree to which the work of a nursing program is accomplished through the efforts of a nursing group” (Sieloff, 1995, p. 58 as cited in Sieloff, 2007, p. 207) The knowledge and skills of the group leader in relation to the achievement of group goals/outcomes (Sieloff, 1996). The knowledge and skill related to the giving of information from one group to another group (Sieloff, 1996). Achieving “events that are valued, wanted or desired” (King, 1981, p. 145) by a group. The perception and value regarding the achievement of goals/outcomes (Sieloff, 2007, p. 207)
Equal to the group's empowerment capacity interacting with four mediating variables or leadership competencies, measured by the total score on the instrument (Sieloff and Bularzik, 2011). Obtained by the total of four SKAGEO© subscale scores: a) controlling the effects of environmental forces, b) position, c) resources, and d) role. Measured by items number 4, 8, 9, 10 and 16 on the instrument.
Position (P)
Resources (RE) Role (RO)
Group leader's empowerment competency (GLOAC) Communication competency (CC) Goal/outcome competency (GOC) Empowerment perspective (OACP)
relabeled as equivalent to empowerment capability (actualized empowerment capacity) (Sieloff and Bularzik, 2011). These final semantic revisions resulted in the theory and instrument being semantically revised to the theory of group empowerment within organizations and the Original Instrument was relabeled (Sieloff, 2012). Sieloff defined empowerment as the ability of a group to achieve outcomes. However, empowerment also consisted of two sub-concepts: a) empowerment capacity [a group's potential to achieve outcomes], and b) the actualization of that capacity or empowerment capability. Sieloff conceptualized empowerment capacity as consisting of four factors: (a) controlling the effects of environmental forces, (b) position, (c) resources, and (d) role. In an effort to explain why some groups did not empower themselves in spite of the presence of these four factors, Sieloff identified four mediating factors that interacted with a group's empowerment capacity to result in the group's empowerment capability (empowerment) (1995). She identified these factors through observations, and labeled them as follows based on the results of a review of the literature: (a) communication competency, (b) goal/outcome competency, (c) group leaders' empowerment competency and (d) empowerment perspective. In summary, empowerment is defined as implementation of the capacity of a group to achieve its goals (Sieloff and Dunn, 2008) and is viewed as both a process and an outcome. Empowerment is conceptualized as an active process as opposed to the passing of authority and responsibility to individuals at lower levels in the organizational hierarchy (Bowen and Lawler, 1995). Theoretical assumptions are that
Measured by items number 6, 14, 32 and 33
Measured by items number 5, 15, 19, 20, 21, and 27 on the instrument. Measured by items number 12, 13, and 22 on the instrument.
Measured by items number 1,7,18 and 28 on the instrument Measured by items number 11, 26, and 29 on the instrument. Measured by items number 2, 17, 30 and 31 on the instrument. Measured by items number 3, 23, 25 and 34 on the instrument.
each nursing work team or group has an empowerment capacity and the ability to use that capacity (capability). 2.4. Description, Administration and Scoring of the Instrument The Original Instrument is a 36 item Likert scale instrument. The 20 items related to empowerment capacity measure a group's resources, capacity to adapt to environmental effects, and the group's capacity to achieve outcomes within larger organizations. The mediating factors (communication competency, empowerment perspective, goal/outcome competency, group leader's empowerment competency) mediate a group's ability to actualize its empowerment capacity. Group leaders and members can complete the instrument and their group empowerment capacity and capability are determined by comparing the group scores to a scoring grid. 2.4.1. Instrument Validity Psychometric analysis of the Original Instrument was initially confirmed (N = 334) with a Content Validity Index (CVI) of 92% and Cronbach's alpha of 0.92 (Sieloff, 1999). Subsequently, the instrument has demonstrated consistent reliability and validity worldwide (Sieloff, 1996, 1999; Sieloff and Bularzik, 2011; Bularzik et al., 2013; Viinikainen et al., 2015). Confirmatory factor analysis was completed to determine whether the relationships in the Original Instrument's first proposed eight factor model were compatible with data variance and covariance matrix.
Table 2 Content Expert Characteristics. Age
Gender
Years nursing education experience
Exact job position
Initial level of nursing education
Highest level of nursing education
Area of expertise
Major area of research/publications
72
F
40
Diploma
PhD nursing
Family/community health
Health promoting behavior
65 71 65 65 59
F F F F F
19 71 65 65 59
Assistant professor (retired March, 2012) Associate professor Clinical instructor Chairperson Associate dean Retired nurse executive
AD BSN BSN BSN BSN
PhD nursing Master's degree nursing PhD nursing PhD nursing DNP
Nursing administration Mental health nursing Adult and gerontology Leadership Critical care
Group empowerment Roy adaptions model Academic nursing centers leadership Caring theory and practice
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Table 3 Instrument Subscales with Original and Revised Items. Subscale
Original item
Revised item
Controlling the effects of environmental forces Communication competency
Client outcomes are directly linked to the group's interventions. The attainment of outcomes by the group is enhanced through communication with other organizational groups. The desired outcomes for the group provide for the development of the clinical competence of the group members.
Student outcomes and competencies are directly linked to the group's interventions. Empowerment is enhanced through communication with other organizational groups. The desired outcomes for the group provide for the development of the teaching effectiveness of the group members. The group leader understands how other groups utilize their group's empowerment. Empowerment is essential to assure that relationships within the organization are maintained to achieve the group's desired outcomes. Professional development programs adequately respond to the needs of the group members. The group coordinates the delivery of the curriculum.
Goal/outcome competency
Group leader's outcome attainment competency Empowerment perspective
Resources Role
The group leader understands how the attainment of outcomes is utilized by others within the organization. The attainment of outcomes is essential to assure that relationships within the organization are maintained to achieve the group's desired outcomes. Staff development programs adequately respond to the needs of the group members. The group coordinates the delivery of client care.
Note: Sample Items from the Sieloff-King Assessment of Group Power within Organizations, 1996.
Results indicated second order confirmatory factor loadings ranged from .43 to .89. The overall fit of the final respecified eight first order factor model with ten items deleted was χ2 (291, N = 350) = 504.70, p b .00; GFI = .90, CFI = .94, and RMSEA = .05 (Sieloff and Dunn, 2008, p.120). The authors concluded these findings supported the theory and instrument, and additional efforts to refine and revise the instrument should continue routinely with each new study (Sieloff and Dunn, 2008).
3. Methods 3.1. Design The research design was a concurrent nonexperimental survey design. The concurrent focus was consistent with the conceptualization of the variable (group empowerment) as a trait variable that could vary over time within the academic setting. The research was conducted in two phases: (a) content validity of the Revised Instrument, and (b) confirmatory factor analysis of the same instrument.
3.2. Protection of Human Subjects As a routine practice, the research was submitted to the institutional review board (IRB) for review, and approval was received prior to data collection. No risks to the participants or their psychological well-being were identified as the result of participating in the study. No discrimination occurred in the selection of the participants as a research assumption was that all nurses and nursing groups have both an empowerment capacity and capability. In addition, permission was obtained to revise the Original Instrument for use in the academic setting (Sieloff, personal communication, October 10, 2012).
3.3. Initial Revision of the Original Instrument In preparation for utilizing the Original Instrument within an educational site, this researcher modified the instrument by changing items reflecting clinical outcomes within an acute care setting to, instead, characterizing student outcomes within nursing education. In this context, the ‘group leader’ was the ‘chief administrative officer of the program’, the ‘nursing group’ was the ‘faculty’, and the ‘patients’ were the ‘nursing students’ as they are the recipients of the ‘nursing group's’/faculty's interventions. For example, changes included: (a) client care to curriculum, (b) clinical competence to teaching effectiveness and (c) client needs/acuity data to student numbers.
3.4. Content Validity Nursing education experts were recruited to evaluate each of the 36 items of the Revised Instrument for sufficiency, relevance, clarity, and adequacy of response items. In addition, participants were asked to provide suggested revisions for items deemed unclear or lacking representation of the concept of group empowerment. Three groups of experts were solicited for the content analysis: (a) nurse scholars familiar with Dr. King's work, (b) expert nurse educators and academic administrators and (c) scholars who were familiar with the body of research regarding nursing empowerment. The first group was contacted as these individuals would be familiar with the Original Instrument and be able to provide expertise in terms of revisions needed for the change in context from the clinical to the academic setting. The second group was contacted in order to provide context expertise in the review of the items. And, the third group was contacted in order to provide expertise in the content area of nursing empowerment. No assessment of the level of empowerment of the possible experts was done as it was assumed that all nurses and nursing groups have both an empowerment capacity and capability. An online request for assistance was sent to members of the King International Nursing Group (personal communication February 7, 2013), and was mailed electronically February 7, 2013. Using the snowball approach, additional experts were solicited. Seven experts met the above criteria (familiarity with the theory, expertise in the academic context and expertise in the content area of nursing empowerment). However, one of the seven was too ill to complete the survey by the designated due date. The resulting sample of six experts was deemed to be appropriate as at least five experts should be used when establishing content validity (Norwood, 2010). 3.4.1. Procedure After the content review experts were selected, they were provided with a list of behavioral objectives that had guided the instrument development, a definition of terms, and a list of instrument items (Waltz et al., 2010) using Qualtrics online software (Qualtrics, Provo, UT). The survey was distributed and completed within a time frame of 11 days. Participants were asked to rate each item on a Likert scale of one to four: a) not relevant, b) unable to assess relevance without item revision or item is in need of such revision that it would no longer be relevant, c) relevant but needs minor revision, and d) relevant (Lynn, 1986). In addition, participants were reminded that any reference to a group referenced to the group as a whole, within their organization, and not the specific individuals
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Table 4 Sample Characteristics. Frequency (%)
Gender Age
Highest nursing degree
Primary race/ethnic group
Academic rank
Type of academic organization
Number of baccalaureate students
Geographic area
Male Female 20–38 years old 39–50 years old 51–70 years old N70 years old Masters in nursing Masters in another discipline PhD in nursing PhD in another discipline DNP Asian Caucasian Hispanic Native American Other Instructor Assistant professor Associate professor Full professor Other Health science center Private State funded university Research university b200 201–300 301–400 401–500 501–600 601–700 N701 Mid-west North Atlantic South West
within that group. As a final point, participants were advised that the group leader for purposes of this study was the chief administrative officer for the school of nursing as defined by The Commission on Collegiate Nursing Education (CCNE).
Administrator(N = 79)
Faculty(N = 241)
2(2.0) 77(98) 0 5(6.3) 72(91) 3(2.7) 2(2.5) 0 43(54.4) 34(43.1)
17(7) 224(93) 34(14) 66(27.4) 114(47.3) 0 106(44) 3(1.2) 117(49) 15(7)
1(1.3) 75(94.9) 1(1.3)
2(.83) 231(95.8) 3(1.2) 1(.41) 4(1.7) 63(26) 106(44) 70(29) 2(.8) 0
1(1.3) 0 2(2.5) 19(24.1) 57(72.1) 1(1.3) 3(3.8) 43(54.4) 33(28) 1(1.3) 6(7.62) 17(21.5) 19(24) 19(24) 5(6.3) 6(7.7) 7(8.9) 55 (17) 64(20 155(49) 46(14)
3.4.2. Data Analysis Based upon the experts' reviews, the Content Validity Index for each item (I-CVI) was first calculated by identifying the number of experts who rated each item relevant (3 or 4) and then dividing that number
Table 5 Validity Testing of Subscales Faculty and Administrator Subscales. Subscale
CC CEEF GLOC GOC OACP P RE RO Spearman Split Half/Guttmann administrator Cronbach alpha
Correlation between forms Spearman Brown Coefficient Equal Length Guttmann Split Half Coefficient Uneven Length Spearman Split Half/Guttmann faculty
Correlation between forms Spearman Brown Coefficient Equal Length Guttmann Split Half Coefficient Uneven Length
Administrator (N = 79)
Faculty (N = 241)
Cronbach alpha
Cronbach alpha
.63 .91 .59 .74 .81 .71 .79 .87 Part 1 value(N = 18) .869 Part 2 value(N = 18) .846 .830 .907 .907 Part 1 value (N = 18) .922 Part 2 value (N = 18) .909 .878 .935 .935
.77 .90 .68 .79 .80 .81 .86 .88
Note: CC = communication competency, CEEF = controlling the effects of environmental forces, GOC = goals/outcomes competency, GLOAC = group leader's outcome attainment competency, OACP = outcome attainment perspective, P = position, RE = resources, RO = role.
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4.1. Procedure
Table 6 Model Fit Statistics SKAGPO and Adapted SKAGEO. SKAGPO RMSEA GFI χ2 df p
Adapted SKAGEO .06 .82 1360 586 p b .00
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.069 .786 1383 566 p b .001
Note: SKAGPO = Sieloff-King Assessment of Group Power.
by the number of experts (Lynn, 1986). The I-CVI ranged from 0.67 to 1.00 for the 36 items of the Revised Instrument. When there are six or more judges, the I-CVI should be no lower than 0.78 and at least 0.83 in order to consider the item content valid (Lynn, 1986). Likewise, Polit and Beck reported CVI values of 0.78 with three or more judges can be considered evidence of good content validity (2006). As a result, three items were revised per expert's suggestions prior to use of the instrument. The content validity of the overall Revised Instrument (the S-CVI) was also calculated. This researcher added the number of I-CVIs and then divided by the number of items (S-CVI/Ave) (Polit and Beck, 2008). This value was calculated as being 0.971, greater than the recommended target of 0.90 (Polit and Beck, 2006). This number is also mathematically equal to the average congruency percentage which should be 0.90 (Waltz et al., 2010)
3.5. Qualitative Feedback Three content experts identified four of the 36 items as being unclear. After review, the researcher accepted the expert's recommendations to exclude the language attainment of outcomes and substitute the word empowerment. In addition, item number 27, addressing budgeting, was changed to “Budgeted positions for the groups are determined by student needs”. This modification addressed experts' concerns that the item did not adequately address clinical as well as well as non-clinical courses.
The study was approved by a university human subjects' committee/ institutional review board (IRB). Data collection occurred over a 12week period during two academic terms. A letter describing the study was sent to the administrator of each of the 320 eligible institutions. Once the participating administrators identified a contact person to distribute the surveys, a letter describing the study, along with a hyperlink to the survey was sent to be electronically forwarded to the faculty. Because surveys were sent electronically to participants, completing the questionnaire signified consent to be in the study. 4.2. Data Analysis — Psychometric Examination of the Revised Instrument Data analyses were conducted using Predictive Analytics Software (PASW), version 18.0, for descriptive, reliability, comparative, and correlation analyses (PASW Version 18.0. Chicago: SPSS Inc.). Psychometric evaluation of the instrument in this study was evaluated using Cronbach's alpha, Split-Half Method, Equal Length Spearman Brown Correction Formula. The exact sample size needed for a confirmatory factor analysis has not been identified. However, most agree that from three to 15 times the number of variables to not less than 200 participants is adequate (Stevens, 2012; Loehlin, 2004). The sample size for this study was 320 including surveys which were not used due to incomplete responses (surveys from 25 administrators and 62 faculty). The model tested had 45 observed variables, thereby meeting both of the above conditions. In order to verify the goodness of fit with this sample of nurse educators and administrators, factorial validity of the Revised Instrument was determined using AMOS software (Arbuckle, 2006). Eight first order factors, previously identified for the Original Instrument were used for the analysis (Sieloff and Dunn, 2008). Several indices of fit were utilized, including the root mean square error of approximation (RMSEA) and Goodness of Fit Indices (GFI). RMSEA expresses fit per degree of freedom of the model and ranges from 0 and 1, with smaller values indicating better fit. Acceptable RMSEA (b.08–.05) and acceptable GFI (N.95) were used for this study (Schumacker and Lomax, 2010). 5. Results
4. Confirmatory Factor Analysis 5.1. Model Fit Following the finalization of the Revised Instrument, the second phase of the research was begun to gather the data for the confirmatory factor analysis portion of the continuing psychometric examination of the Revised Instrument. The population for this study was approximately 15,282 administrators and faculty from 335 AACN member schools offering baccalaureate and higher degrees in the United States with 16 or more full-time faculty (Yan Li, personal communication, April 11, 2013). A minimum of 16 faculty was selected to accommodate schools that were smaller with fewer resources. Since, the response rate for this study was anticipated to be somewhere between 40 and 60%, and it was necessary for the school administrators to agree to participate in order to obtain faculty support, cover letters requesting participation in the project were electronically sent to all 335 deans of nursing. Of these emails sent, 15 deans were out of the office, or no longer in the dean position, reducing the sample size to three hundred twenty schools. The study sample involved 241 full-time faculty and 79 administrators who agreed to participate in the study from 79 colleges of nursing who were members of the American Association of Colleges of Nursing (AACN) and represented four geographic areas including southern, north-eastern, mid-western and the western United States. Although equal strata were desired, the final sample did not result in a geographically representative sample.
Second-order confirmatory eight factor analysis of the Revised Instrument was calculated using AMOS (Arbuckle, 2006). Factor loadings ranged from .455 to .960. The standardized regression weights for each latent construct were found to be sufficient except for one item that loaded with a negative loading of −0.38. This item [the attainment of outcomes is essential to assure that the desired outcomes of the organization, the group and the individual members with the group are consistent] had not been identified by experts as needing revision during the content validity study. Likewise, the alpha for the one scale associated with this question was greater than .70 in both administrator and faculty groups (0.81 and 0.80 respectively). The CFA was computed without this item, and the model fit was not affected after removing the item, nor was the overall fit improved. The overall fit of the measured model was compared to the CFA reported on the Original Instrument (Sieloff and Dunn, 2008). The current model findings suggested an acceptable fit with the data including GFI = .786, RMSEA = 0.69. A power analysis for these using guidelines in Schumacker and Lomax (2010) indicated 1.0. The statistical significance of each factor loading was also examined and all factor loadings were found to have a critical ratio (CR) greater than 1.96 except for question three which had a CR of −.648. Modification indices for the regression weights were also examined to identify cross-
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loadings and all regression weights are statistically significant except (OAP). However, when this item was omitted, the fit of the model did not improve. Suggestions for future research include qualitative analyses of the item to determine if the item is needed or to identify a new item that measures the construct more effectively. 6. Discussion This research has implications for many areas of nursing: practice, education, management and future research. In terms of practice, one should consider the practice to be within the academic setting with faculty acting as ‘nurses’ and the students as the nurses ‘clients’. By assessing the faculty group's empowerment, the faculty members can develop strategic plans to increase their group empowerment based on their scores on the instrument's items. By improving their group's empowerment, they will be able to improve their work environments and, subsequently, increase the job satisfaction and retention and recruitment of faculty members. 6.1. Implications for Education In terms of nursing education, faculty who are fully informed of their level of group empowerment may subsequently assist students to increase their own awareness of group empowerment both in the classroom and the practice setting. Through this increasing selfawareness, educators may be able to assist student groups to also gain understanding of the relevance of group empowerment to the safety and quality of patient care. Lastly, those nursing schools that facilitate faculty group empowerment may encourage others to choose academics and administrative positions as a viable career option, thereby strengthening the future of the profession. 6.2. Implications for Management Administrators who can measure group empowerment capacity and capability with one instrument may have the advantage as they recruit and preserve nurse faculty. The ability to measure and report group empowerment may also assist administrators to increase their visibility within their individual organizations by effectively capturing their capability to achieve outcomes. Ultimately leaders who value group empowerment may be better prepared to create and support academic environments where faculty can prepare advanced practice and baccalaureate prepared nurses who are themselves empowered team members. 6.3. Implications for Research A recommendation for future studies is to refine items on subscales communication competency, and goals/outcome competency that had low Cronbach alphas in the original study, precluding their use in the correlational analyses. In addition, future research should include open ended questions to gather valuable qualitative data. Additionally, although the findings of this study suggest faculty groups are empowered, further studies with larger more geographically diverse samples are warranted. Replicating the study in other countries would also strengthen the understanding of global group empowerment in nursing education. 7. Limitations Content validity is inherently biased since feedback from experts is subjective and participants were not asked to identify content that may have been missing from the instrument. The fact that all participants were from the United States may also create bias due to cultural values regarding empowerment. The low response rate of participating faculty from selected schools in this study sample is a limitation. This
may be attributed to the timing of data collection during the end of spring semester when faculty members are busy. Low response rates may also be a result of not having direct access to faculty. Faculty who felt less empowered may have been reluctant to participate as the survey was primarily distributed by administrators or their designated staff. Furthermore, as with faculty, less empowered administrators may have also been reluctant to participate. Incomplete responses prohibited analyzing surveys from 25 administrators and 62 faculty members. The sampling method also prohibits generalization since deans were recruited from a stratified list of schools using single staged sampling in order to increase faculty participation. 8. Conclusions In this study, content validity and confirmatory factor analysis was completed for the Revised Instrument, a revision of the Original Instrument adapted for use in nursing education. Content validity was sufficient (SCIV/Ave 0.971) and confirmatory factor analysis (CFA) suggested the adapted instrument and theoretical model had an adequate fit with the data. The analyses of reliability and validity demonstrated strong psychometric properties except for one item in subscale ‘empowerment perspective’ that may need further refinement in future studies. The ability to alleviate the global nursing shortage depends upon an ample supply of faculty who are satisfied with their jobs and who remain in nursing education. The Revised Instrument addresses both fiscal and physical resources, academic support services and leadership competencies associated with group empowerment. The capability to measure faculty group empowerment may facilitate the retention of current educators and the recruitment of additional faculty. Testing and verifying nursing theory by confirmatory factor analysis (CFA) is an important phase of obtaining discipline specific knowledge since CFA requires a strong conceptual foundation to guide the specification and evaluation of the factor model (Brown, 2015). The theoretical variables of the Sieloff King Theory of Group Empowerment were supported by the findings within this sample. This study increased the understanding of group empowerment within nursing education based upon a nursing theory and a single instrument incorporating multiple measures. Ongoing research should be completed to continue to further refine and revise the instrument. Likewise, using the instrument in nursing programs worldwide may also enable cross cultural efforts by educators and their leaders to identify and support empowered work environments. Leaders across the world have advocated for revised relevant nursing pedagogy where adult learning principles, seamless entry, and virtual learning are embraced. These efforts will ultimately require creative faculty and administrators who work in empowered environments. References Alligood, T., Tomey, A.N., 2010. Nursing Theorists and Their Work. Mosby Elsevier, Maryland Heights, MO. Arbuckle, J.L., 2006. Amos (Version 7.0) [Computer Program]. SPSS, Chicago. Baker, S.L., Fitzpatrick, J.J., Griffin, M.Q., 2011. Empowerment and job satisfaction in associate degree nurse educators. Nurs. Educ. Perspect. 32, 234–239. Bowen, D.E., Lawler, E.E., 1995. Empowering Service Employees. MIT press, Cambridge, MA. Brancato, V.C., 2007. Psychological empowerment and use of empowering teaching behaviors among baccalaureate nursing faculty. J. Nurs. Educ. 46 (12), 537–544. Brown, T.A., 2015. Confirmatory Factor Analysis for Applied Research. Guilford Publications, New York. Bularzik, A.M., Tullai-McGuinness, S.T., Sieloff, C.L., 2013. Nurse's perceptions of their group goal attainment capability and professional autonomy: a pilot study. J. Nurs. Manag. 21 (3), 581–590. Butts, J.B., Rich, K.L., Fawcett, J., 2012. The future of nursing: how important is disciplinespecific knowledge? A conversation with Jacqueline Fawcett. Nurs. Sci. Q. 25 (2), 151–154. Cowden, T., Cummings, G., Profetoo-Mcgrath, J., 2011. Leadership practices and staff nurses' intent to stay: a systematic review. J. Nurs. Manag. 19 (4), 461–477. Evans, Sieloff, C.L., 1989. Development of a departmental theory of power within Imogene King's framework: Unpublished manuscript.
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