Key implications for managers and health administrators include the following. First, although the LTCF staff members reported feeling psychologically empowered, particularly in the areas of meaning and competence, there is still room for the development of more positive work environments as indicated by the lower scores for self-determination and impact. Psychological empowerment contributes to staff engagement (Stander and Rothmann, 2010). Staff engagement in turn impacts on quality of care (Haugan et al., 2013). Organisational leadership must create work environments in which staff perceive that their work as meaningful and where they feel that they can shape events (May et al., 2004). This may involve the support of a less hierarchical organisational structure (Frey et al., 2015b). Increasing empowerment in organisations can involve power-sharing with staff members (Yukl and Becker, 2006). Psychological empowerment can also be increased with workplace learning (Zahrani, 2012). In the LTCF sector in developed countries where there are increasing numbers of both newly graduated and/or migrant nurses (Ortiga, 2018), it is vital for managers to support mentorship in the form of both senior staff members and external educators (e.g. hospice nurse specialists) to empower newer staff (McKinley, 2004) and to enhance care delivery confidence (Xu, 2010). Results of this and previous research support the importance of educational interventions that fit the context of LTCF for building staff confidence in palliative care delivery (Frey et al., 2017). Increasing resource constraints and staff shortages may affect the capacity for mentoring within LTCF however. Mentoring may be difficult for experienced staff already carrying heavy workloads, therefore managers must consider the implications of staffing levels for staff self-confidence and ultimately care delivery quality (Cho et al., 2006).
6. Strengths and Limitations
Limitations to the current study include a sampling strategy that relied on LTCF managers to nominate staff members. However, the recruitment strategy aimed to ensure representation of staff members most closely involved in the care of a dying resident, therefore requiring some prior experience in the delivery of end of life care. Furthermore, gathering data from several sites across the region also increases the generalisability of the quantitative results to some extent. Another potential limitation of the study was the use of the self-assessment questionnaire, which is by its very nature subjective (Stewart et al., 2000). Thus, self-reported palliative care delivery confidence may not translate into the staff members’ actual abilities in the delivery of palliative care (Woolliscroft et al., 1993).