1. Self-Transcendence and Work Engagement in Acute Care Staff Registered Nurses Beth Palmer DNP, RN, ANP-BC, CNS, CCRN November 13, 2008

2. Background People frequently choose to become nurses because caring for others brings meaning to their lives and gives them a sense that they are making a difference in the world. Registered nurses often choose to work in acute care facilities because they find meaning in caring for patients who are acutely and/or critically ill.

3. Background The desire to find meaning through one’s work - consistent with philosophy of Victor Frankl Frankl believed: striving to find meaning in life is primary motivational force in mankind Self Transcendence: The ability of human beings to find meaning in their lives by being directed toward something, or someone, other than themselves

4. Background Self-Transcendence  + meaning When nurses derive meaning from caring experiences  increased commitment and engagement with their work

5. Problem Self-transcendence  +meaning Self-transcendence may be connected to nurses’ relationship with their work The relationship between self-transcendence and work engagement has not been investigated

6. Purposes To explore the levels and relationships of self-transcendence and work engagement in Acute Care Staff Registered Nurses.

7. Theory of Self-Transcendence Adapted from: Reed, P. (2003). The Theory of Self-Transcendence. In M. Smith & P. Liehr (Eds.), Middle Range Theory for Nursing. New York: Springer Publishing Company, Inc.Adapted with permission of the author

8. Research Questions 1.What is the level of self-transcendence in Acute Care Staff Registered Nurses? 2.What is the level of work engagement in Acute Care Staff Registered Nurses? 3.What is the relationship between self- transcendence and work engagement in Acute Care Staff Registered Nurses?

9. Literature Review Self Transcendence (ST ) Is Universal +Correlates with emotional well-being, spiritual well-being, sense of coherence, self esteem, hope, purpose in life, resilience, quality of life, health status, Nurses experience ST when they have life-changing encounters with patients Work Engagement (WE) +Correlates with Workplace job control job resource availability service climate autonomy appreciation +Correlates with Personality extraversion mobility achievement striving In nurses: Introspection leads to return to work engagement

10. Research Methods Descriptive, correlational study design Setting: National Teaching Institute (NTI) - annual national conference of the American Association of Critical Care Nurses 2008: held in large city in northern Illinois Sample –Population: 9,000 registered nurses –Power analysis: minimum sample size of 64 (.05 significance level, 80% power, effect size of 0.3)

11. Operational Definitions Self-Transcendence Independent variable –Self-Transcendence Scale (STS) –Validity reported –Internal reliability coefficient (.73-.93) Work Engagement Dependent variable –Utrecht Work Engagement Scale (UWES) –Validity reported –Internal reliability coefficient (.91-.96)

12. Demographic Questionnaire Age Gender Ethnicity Years in nursing Years of employment Educational level Work status Percentage of time spent in direct patient care Area worked Work-related role Certification status Additional question: “To what extent does your work in nursing give you an awareness of the vulnerability of human beings?”

13. Recruitment & Procedure Exempt status from Case Western Reserve University IRB Investigator seated at table in exhibition hall Participants who completed surveys received candy bar

14. Sample Characteristics Personal –Female (94.3%) –Caucasian (81.6%) –Age 41-50 years (32.2%) 51-60 years (28.7%) –Highest Nursing Degree Associates Degree (36.8%) Bachelors Degree (48.4%) Work –# of years in nursing 1-15 years (50.5%) 15->30 years (48.2%) –Certification (51.7%) Certified by AACN (10.3%) Other Certification

15. Instrument Reliability STS Cronbach’s alpha =.79 UWES Cronbach’s alpha =.90 Subscales Vigor =.80 Dedication =.85 Absorption =.70

16. Research Questions 1 & 2 1.Level of Self-Transcendence Mean STS score = 3.41, SD=.32 2.Level of Work Engagement Mean UWES score = 4.61, SD=.61

17. Research Question 3 STS UWES total.36** Vigor.40** Dedication.35** Absorption.23* Relationship between Self-Transcendence and Work Engagement **Correlation is significant at the 0.01 level *Correlation is significant at the 0.05 level

18. Additional Question To what extent does your work in nursing give you an awareness of the vulnerability of human beings? Very Much (76%) Somewhat (23%) Indicates that these acute care nurses likely experience vulnerability relating to their work

19. Discussion Sample and Instrument Reliability Participants fairly representative of the overall population Reliability coefficients for study instruments were acceptable and similar to those in previous studies

20. Discussion Results of Research Questions Level of self-transcendence: similar nurses in 2 prior studies Level of self-transcendence higher than non-nurses Level of work engagement in this study –Total UWES: High end of “Average” –Vigor & Absorption: High end of “Average” –Dedication: “High”

21. Discussion Results of Research Questions Significant positive correlation: Self-Transcendence & Work Engagement

22. Limitations Use of convenience sample Minimally acceptable STS reliability coefficient Low UWES absorption subscale reliability coefficient

23. Implications Nursing administration - encourage and provide opportunities for nurses to self-transcend Clinical Nurse Specialists - model, nurture, and educate staff about self-transcendence Nursing educators - support students to incorporate experiences of vulnerability into development of self- transcendence  meaning in patient-care experiences

24. Future Research Replication Intervention Testing Crossover of work-engagement in nurses Research must focus on discovering how to support the positive, fulfilling, work- related state of mind that will keep nursing a vibrant, fulfilling and meaningful profession

25. Conclusion First study exploring relationship between Self- Transcendence (ST) and Work Engagement (WE) Significant positive relationship found between ST and WE - Nurses with higher levels of self-transcendence had more energy toward and were more dedicated and absorbed in their work Key finding relating to nursing and nursing faculty shortage By teaching and nurturing self-transcendence in nurses we can prepare and retain work-engaged nurses who will thrive in and benefit our challenging and constantly changing healthcare environment.

26. Thank you! Questions & Discussion