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Exploring belongingness in nursing practice: A phenomenological study

Dissertation
Author: Sharon J. Paton
Abstract:
The purpose of this qualitative study, from a phenomenological approach, was to explore nurses' understanding of belongingness and the influence this knowledge could have for nurse leaders on job satisfaction and retention of nurses. Fifteen Registered Nurses (RNs) from a health care organization in Toronto, Canada, took part in the study. From the interviews conducted, holistic, selective, and line-by-line analysis of transcripts occurred. The use of NVivo 8 software during data analysis assisted in identifying themes. Four core themes emerged: Belongingness relates to possessing a feeling of happiness and a sense of family; creating belongingness is primarily the responsibility of nurse leaders; organizations have a responsibility for ensuring a culture of belongingness exists; for novice nurses to remain in practice acquiring a sense of belongingness is essential. Implications are nurse leaders and organizations must commit to creating environments where nurses hold a sense of belongingness. Recommendations include organizational reviews of current barriers to creating caring and supportive practice settings, and for nurse leaders at all levels of an organization to focus on the concept of belongingness in creating nursing practice environments conducive to retaining nurses.

Table of Contents

List of Figures .......................................................................................................... xii

CHAPTER 1: INTRODUCTION .............................................................................. 1

Background of the Problem ....................................................................................... 2

Statement of the Problem ........................................................................................... 7

Purpose of the Current study...................................................................................... 8

Significance of the Problem ..................................................................................... 10

Nature of the Current Study ..................................................................................... 12

Overview of the Research Method .......................................................................... 12

Overview of the Design Appropriateness ................................................................ 12

Research Questions .................................................................................................. 15

Theoretical Framework ............................................................................................ 16

Definition of Terms.................................................................................................. 21

Assumptions ............................................................................................................. 22

Scope and Limitations.............................................................................................. 23

Delimitations ............................................................................................................ 24

Summary .................................................................................................................. 25

CHAPTER 2: REVIEW OF THE LITERATURE .................................................. 27

Title Searches, Articles, Research Documents, and Journals .................................. 28

Literature Review..................................................................................................... 30

Historical Overview ................................................................................................. 30

Current Perspective .................................................................................................. 32

viii

Nurse work environments. ................................................................................ 32

Job dissatisfaction. ............................................................................................ 33

Workplace myths. ............................................................................................. 34

Summary: Work Environments ............................................................................... 34

Belongingness .......................................................................................................... 35

Historical Overview ................................................................................................. 35

Current Perspective .................................................................................................. 39

Education Perspective .............................................................................................. 41

Nursing Perspective ................................................................................................. 42

Summary: Belongingness ........................................................................................ 44

Overview of Leadership Theory .............................................................................. 45

Historical Perspective .............................................................................................. 45

Transactional and transformational leadership. ................................................ 46

Servant leadership. ............................................................................................ 47

Current Perspective .................................................................................................. 50

Wheatley’s living systems model. .................................................................... 50

Kouzes and Posner’s leadership model. ........................................................... 52

Senge’s organizational change model. ............................................................. 54

Summary: Leadership Theories ............................................................................... 54

Nursing Leadership .................................................................................................. 55

Current Perspective .................................................................................................. 55

Belongingness. .................................................................................................. 58

Alternative Viewpoints ............................................................................................ 59

ix

Conclusions .............................................................................................................. 60

Summary .................................................................................................................. 61

CHAPTER 3: METHOD ......................................................................................... 63

Research Method and Design Appropriateness ....................................................... 64

Design Appropriateness ........................................................................................... 67

Exploration of Belongingness .................................................................................. 70

Study ........................................................................................................................ 71

Sampling Frame ....................................................................................................... 71

Informed Consent..................................................................................................... 73

Confidentiality ......................................................................................................... 74

Geographic Location ................................................................................................ 74

Data Collection ........................................................................................................ 75

Instrumentation ........................................................................................................ 78

Validity and Reliability ............................................................................................ 79

Data Analysis ........................................................................................................... 81

Summary .................................................................................................................. 83

CHAPTER 4: RESULTS ......................................................................................... 85

Pilot Study ................................................................................................................ 85

Study Participants .................................................................................................... 86

Demographic Information ........................................................................................ 88

Data Collection Procedures ...................................................................................... 89

Data Analysis ........................................................................................................... 91

Interview Transcription ............................................................................................ 91

x

Data Analysis Process .............................................................................................. 92

Findings.................................................................................................................... 93

Themes ..................................................................................................................... 94

Central question 1. ............................................................................................ 95

Summary: Central Question 1 ................................................................................ 101

Central question 2. .......................................................................................... 102

Summary: Central Question 2 ................................................................................ 117

Central question 3. .......................................................................................... 118

Summary: Central Question 3 ................................................................................ 126

Findings.................................................................................................................. 126

Summary ................................................................................................................ 127

CHAPTER 5: CONCLUSIONS AND RECOMMENDATIONS ......................... 129

Population .............................................................................................................. 130

Conclusions ............................................................................................................ 131

Interpretation of Data Results ................................................................................ 133

Theme One: Sense of Family ................................................................................. 133

Theme Two: Leader Responsibility ....................................................................... 134

Theme Three: Organizational Responsibility ........................................................ 137

Theme Four: Intent to Leave.................................................................................. 138

Personal Interpretation and Reflection................................................................... 141

Significance to Leadership ..................................................................................... 143

Study Assumptions and Limitations ...................................................................... 148

Recommendations for Leadership ......................................................................... 148

xi

Recommendations for Future Research ................................................................. 150

Conclusion ............................................................................................................. 150

REFERENCES ...................................................................................................... 153

Appendix A: Letter of Collaboration ..................................................................... 175

Appendix B: Permission to Enter Premises ........................................................... 177

Appendix C: Introductory Letter ........................................................................... 179

Appendix D: Consent Form ................................................................................... 181

Appendix E: Interview Script ................................................................................ 187

Appendix F: Letter of Appreciation ....................................................................... 191

Appendix G: Demographic Information ................................................................ 193

xii

List of Figures Figure 1. Literature map

.......................................................................................... 29 Figure 2. Illustration of belongingness related to research questions and data analysis.

.................................................................................................................. 140

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CHAPTER 1: INTRODUCTION Globally, nursing shortages have reached critical proportions because more than half of novice nurses leave the profession within the first two years of practice, contributing to a critical shortage of nurses (Chaguturu & Vallabhaneni, 2005; Kiekkas, et al., 2008; Ledgister, 2003; Numata, et al., 2006; Thompson, Navarra, & Antonson, 2005). As a result of the ensuing increased workloads, a massive exodus of nurses novice and experienced from the profession is occurring (Begat, Ellefsen, & Severinsson, 2005; Bowles & Candela, 2005; Kiekkas et al.; McIntosh, Palumbo, & Rambur, 2006; Rambur, McIntosh, Palumbo, & Reinier, 2005). A lack of respect from nurse leaders, other health care professionals and the public, unsupportive work environments, and untenable workloads have forced the largest segment of professionals, Registered Nurses (RNs), from the profession (Hutchinson, Vickers, Jackson, & Wilkes, 2005; Ledgister, 2003; Sheppard, 2006). Although research related to belongingness exists, very little information about this topic from a nurse perspective is available. While the current rate of admissions to nursing schools is encouraging, the attrition rate of novice nurses is alarming considering the increased demands on nurses due to an aging population and escalating co-morbidity issues in patients. Intensifying attrition rates of nurses is the continuing lack of nurse leadership throughout many organizations (Failla & Stich, 2008). Introduced in Chapter 1 is the necessity of exploring the concept of belongingness from the perspective of nurses as despite many studies on job dissatisfaction, nurses continue to leave practice at an alarming rate. The exodus of nurses from health care organizations place patients at risk for unsafe care and position nurses for high rates of

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injuries and other health related issues (Bowles & Candela, 2005). Discussion in this chapter includes a background of the problem, problem statement, purpose, significance, and nature of the research, and the central questions related to this current study. Background of the Problem Admissions to nursing schools have increased considerably from 1998, up by 43% from 1999 to 2001 (Buerhaus, Donelan, Ulrich, Norman, & Dittus, 2005). Kaufman (2010) reported, despite the recession and a slight decline in admissions during 2005- 2006, since 2008, the majority of nursing schools turned away applicants due to increased numbers of high school and second-degree students focusing on a career in nursing. Despite increased interest, the reality is that increasing retention issues continue to be a concern for nurse leaders as identified through the exorbitantly high rate of new graduates leaving within the first one to two years of practice (Bowles & Candela, 2005; Lavoie-Tremblay et al., 2008; McIntosh, et al., 2006; Nogueras, 2006). Despite the fact statistics vary somewhat between researchers, the percentage of nurses leaving practice is high in all studies (Bowles & Candela, 2005; Buerhaus et al., 2005; Takase, Maude, & Manias, 2005). Although a nursing shortage has prompted many studies to determine why nurses leave active practice, and researchers have identified issues such as a lack of mentorship, poor leadership, heavy workloads, and an uncaring work environment as causes for this development, scant attention to belongingness in nursing practice exists (Lavoie- Tremblay et al., 2008). Exploring the lived experience of registered nurses is important to understand the possible influence belongingness might have for creating supportive and caring work environments. Addressing the concept of belongingness, in

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consideration of building supportive practice environments from the perspective of staff nurses might enlighten nurse leaders how to sustain nurses in health care institutions as nurses continue to express a sense of loss in connection with nurse leaders (Bally, 2007; Cohen, 2006; Gutierrez, 2005; Kim, Park, & Han, 2007). Wheatley (2006) identified the need for humans to have a sense of connection, and described how communities have become increasingly fragmented and unsupportive. Kouzes and Posner (2007) reflected on the importance of interdependence, and called for developing supportive communities built on caring practices. The responsibility for creating a supportive work environment thought to rest primarily with nurse leaders, does not address current reality as many are not adequately prepared to focus on such a challenge (Contino, 2004; Sheldon & Formella, 2004; Shirey, 2006; Sporrong, Arnetz, Hansson, Westerholm, & Hoglund, 2007; Weston, Falter, Lamb, & Mahon, 2008). An important point to consider as nurses express feelings of moral and ethical distress related to current work settings (Begat et al., 2005). When describing shortcomings in the education system, Dewey (1938) described when compromising the spirit of individuals, the environment cannot change. Belongingness essential for a person to have a sense of security, support, and respect may address the absence of spirit as described by Dewey, and provide a unique opportunity to explore belongingness within nursing practice settings. Comparing the literature between educational environments and health care settings is appropriate as nurses and teachers form a female majority in both professions (Coleman, 2004). Senge (1999) emphasized the need to rethink existing practices and become more creative and supportive in

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organizations’ work settings, essential to nursing practice, as current settings are not meeting the needs of nurses (Thompson et al., 2005). Belongingness, although significantly studied within the education realm, has received little attention in nursing practice (Levett-Jones, Lathlean, McMillan, & Higgins, 2007). Despite the fact limited research related to belongingness in nursing practice exists, comparisons between teachers and nurses inform the current study as women remain the largest proportion of workers in both professions (Coleman, 2004; McIntyre, Thomlinson, & McDonald., 2006; Olsen, 2009). Olson identified female teachers under the age of 30 are leaving the teaching profession at an alarming rate. Comparable to nurses, the causes of this problem relate to lack of autonomy, working within a male-dominated hierarchal structure and lack of support (Coleman, 2004; Olson, 2009). Studies have shown creating a positive school environment, one where teachers hold a sense of belongingness, improves the school atmosphere and satisfaction of teachers (Booker, 2006, 2007; Gore, 2005). The significance of belongingness in nursing practice is far reaching. As discussed in education research, belongingness influences teacher satisfaction and retention rates (Olsen, 2009). The implication is a lack of belongingness may influence nurses to leave the profession prematurely (Cohen, 2006; Gutierrez, 2005; Takase, et al., 2005). The resulting heavy workloads nurses must endure, due to a decreased ratio of nurses to patients, has led to inadequate patient care and dissatisfied nurses (Begat, et al., 2005; Bowles & Candela, 2005; Donley, 2005; Forchuk & Kohr, 2009). Nurses historically have suffered from a poor public image and sense of worth (Bowles & Candela, 2005; McIntyre et al., 2006; Ulrich, 2003). From the time of

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Florence Nightingale, the nursing profession has struggled to gain respect from society and other health care disciplines. The perception of nursing as mainly a female job subordinate to physicians, a sexist portrayal of nurses in the media, and demanding unsupportive work settings provoke nurses to become dissatisfied and unhappy with nursing work (Cohen, 2006; Gallagher, 2007; Ledgister, 2003; McIntyre et al., 2006). Reasons cited by nurses for leaving the profession include issues with work cultures: authoritative managers, work environments restricting intellectual functioning, experienced nurses rejecting novices, and a focus on nurses’ clinical skills rather than attention on recognition and support of nurse autonomy and expertise (Tabari- Khomeiran, Kiger, Parsa-Yetka, & Ahmadi, 2007). Boychuk Duchscher (2001) found nurses remaining in the profession experienced a high percentage of exhaustion, both physical and mental, and suffered from severe episodes of depression within the first two years of entering practice. The need for nurse leaders to consider belongingness in creating supportive work environments to meet nurses’ physical and emotional needs has never been greater. Identified by Wheatley (2006) is the need for humans to have a sense of connection and described how increasingly, communities have become fragmented and unsupportive. Kouzes and Posner (2007) reflected on the importance of interdependence and called for developing supportive communities built on caring practices. Ledgister (2003) and Altun (2008) described how the current lack of empowered leaders in nursing practice is contributing to the dissatisfaction of nurses, and identified until nurse leaders can create appropriate nursing environments existing settings will not change. Senge

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(1999) emphasized the need for leaders to rethink current practices, and become more creative and supportive in organizations’ work settings. Nurses desire work environments providing an opportunity for the provision of excellent patient care, value as a health care professional, and commitment to the profession (Donley, 2005; Lewis, 2007; Manley, 2004; Nogueras, 2006; Ulrich, 2003). Leftridge and Jordan (2005) supported this view, and emphasized how softening nursing environments might help to create a positive work atmosphere. Coleman (2004) found female teachers in a leadership position tended to model male practices when acquiring the ability to lead. As a result, women in a leadership role lean toward overcompensating for gender by exhibiting dominating behaviors as evident in current nursing practice environments (Hutchinson, et al., 2005). Urgent then, is for leaders to support nurses by encouraging a sense of belongingness within nursing practice settings. … Belongingness is defined as the need to be and perception of being involved with others at differing interpersonal levels across varying environments which contributes to one’s sense of connectedness (being part of, feeling accepted, and fitting in), and esteem (being cared about, valued and respected by others). (Somers, 1999, pp. 16-17) The concept of belongingness, derived from psychology and sociology theory, has received much attention in education (Blatner, 2008; Booker, 2006, 2007; De Cremer & Blader, 2006; Gore, 2005; Green, 2005; Meloro, 2005). Increasing awareness of the need to create caring work settings, based on education research related to belongingness, has led to an interest in the phenomenon under study (Levett-Jones, et al., 2007). Ongoing

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nurse dissatisfaction with practice settings is pressuring leaders to understand the meaning of belongingness and learn how to implement such knowledge into practice. Belongingness, according to Maslow’s motivational model (1970), falls in the middle of the hierarchy immediately after meeting basic physiological and safety needs. The placement depicts the significance of belongingness, as without becoming a part of one’s group developing positive self-esteem is impossible according to Maslow. The model emphasizes the value of employers creating environments to meet individual employee needs by supporting workplace settings conducive to the stimulation of personal growth. Levett-Jones et al. (2007), in an extensive literature review, discovered when a sense of belongingness does not exist emotional and physiological manifestations appear. A deficiency in addressing this issue is prevalent throughout nursing practice settings.

Statement of the Problem Ledgister (2003) identified from 1990-2002 the shortage of nurses in Canada more than quadrupled, a trend occurring worldwide. As many nurses are retiring early or vacating nursing practice because of poor working conditions, public and professional devaluing of nursing work and lack of supportive work settings, the nursing shortage has reached critical proportions (Begat, et al., 2005; Bowles & Candela, 2005; Chaguturu & Vallabhaneni, 2005; Ulrich, 2003). Bowles and Candela identified after one year in practice, 38% of novice nurses left the profession. More significant is after two years in practice, 57% abandon nursing as a career. Health care policy and decision makers, educators, and nursing scholars have identified a general problem of health care organizations experiencing a crisis in retaining nurses (Ulrich, 2003).

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The specific problem in addressing the nursing shortage is retaining novice nurses. Exploring nurses lived experience to understand and define belongingness from a nurse perspective may inform nurse leaders how to develop supportive and caring work environments to help stem the loss of nurses from practice. The focus on belongingness could move beyond the plethora of knowledge related to nurse job dissatisfaction and shift toward nurses and nurse leaders creating caring work environments (Al-Hussami, 2008; Belknap, 1984; Bowles & Candela, 2005). Even though many researchers have explored different causes for high attrition rates in nursing, consideration of belongingness as a reason for the escalating numbers of nurses leaving active practice is lacking. Purpose of the Current study The focus of this current qualitative study was to ascertain understanding of belongingness as expressed by nurses in an urban hospital in Toronto, Canada. Exploring nurses’ experiences with belongingness and understanding this term from a nurse perspective might influence current and future leaders’ ability to foster a sense of this concept in practice settings. Interviews with 15 nurses, using open-ended questions, occurred. Assessing themes emerging from data related to the concept of belongingness took place from a phenomenological, hermeneutic approach; appropriate, as understanding the essence of belongingness must come from the lived experience of participants (Burger, n.d.; Ehrich, 2008; Gadamer, 1976; Groenewald, 2004; van Manen, 1990). The nature of hermeneutic inquiry is to explore lived experiences through meaningful and thoughtful reflection of a phenomenon by both the researcher and study

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participants. The intent of the current study was to explore nurses understanding of belongingness by incorporating van Manen’s approach to hermeneutic inquiry as through exploring personal meaning; one can become satisfied with interactions between self and others, leading to building meaning within the workplace. By exploring belongingness from the lived experience of nurses, a phenomenological approach enhances understanding of the phenomenon under study and informs thoughtful self-reflection to influence behavior (Maxwell, 2005). Through perceiving the lived experience, a new awareness may perhaps assist in keeping nurses satisfied with the work environment and in active practice. Suited to the exploration of belongingness from a nurse perspective in creating caring work settings, is a phenomenological study approach as testing theory was not the objective of the current study. Unlike quantitative research, causal explanations were not the focus although through exploring phenomena, qualitative researchers focusing on the question how, and the process itself could make connections with this type of approach to research (Maxwell, 2005). This current study might interest nurse administrators and managers as addressing the need for nurses to experience belongingness could nurture leaders to create supportive practice settings (Bowles & Candela, 2005; Boychuk Duchscher, 2001; Donley, 2006; RNAO, 2006, 2007). This current study is important to all nurse leaders and citizens worldwide as nurses might, if possessing a sense of belongingness, be able to provide increased quality in patient care (Kiekkas et al, 2008; Lavoie-Tremblay et al, 2008; Ledgister, 2003; McIntyre, et al., 2006; Wilson & Ferch, 2005). Creating supportive

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work settings might also prevent premature exodus from the profession and positively influence the current staggering statistics related to nurses leaving practice. Significance of the Problem Although available research on belongingness primarily relates to education, little research connected to belongingness in nursing practice exists (De Cremer & Alberts, 2004; Den Hartog, De Hoogh, & Keegan, 2007; Green, 2005; Lakin, 2003; Lee & Robbins, 1995; Meloro, 2005; van Prooijen, van den Bos, & Wilke, 2004). Lacking is a definition of belongingness from nurses’ perspective; a salient point, as understanding how to create support in the practice setting from the nurse (expert) could increase a nurse’s sense of belonging and desire to remain in practice. The intent of the current study was to understand and define belongingness from the study participants’ perspective, and to investigate how the information gained could inform a nurse leaders understanding of creating supportive and caring work settings leading to increased retention rates. The current study is unique in addressing the lack of research in belongingness related to nursing practice, and adds to current definitions of the term. Nurse satisfaction within the work setting is crucial to maintaining quality patient care and retaining nurses (Al-Hussami, 2008). Nurse administrators and managers worldwide might benefit from the strategies and solutions resulting from the current study, by understanding how nurses perceive the importance of having a sense of belonging in the work environment and take action to increase nurse satisfaction within the practice setting (Lavoie-Tremblay et al.; Ledgister, 2003; Manion, 2004; McIntyre, et al., 2006).

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The first focus of the current study was on the concept of belongingness as identified by nurses. The second focal point was on belongingness in relation to creating caring and supportive work environments. Finally, attention centered on how understanding belongingness could influence job satisfaction for nurses, leading to improved retention rates. Although many theories and a substantial amount of research on leadership development exists, a gap remains in understanding how belongingness influences nurse leaders’ ability to create work environments conducive to job satisfaction and retention of nurses (Levett-Jones, et al., 2007). Addressed in this current study is the present gap on belongingness in nursing practice, through building on research by Baumeister and Leary’s (1995) exploration of belongingness as a fundamental human motivator, Wheatley’s (2005) element of human connectedness, inspirational leadership by Kouzes and Posner (2007), and Senge’s (1999) focus on developing future organizational leaders through creating and sustaining successful work environments. The knowledge gained in relation to belongingness from nurses’ perspective adds to leadership theory, addresses an urgent need for developing effective leadership in nursing practice, and increases current understanding of this phenomenon. Discussion related to transformational leadership (Bass & Steidlmeier, 1999; Feinberg, Ostroff, & Burke, 2005) and servant leadership (Bowman, 2005; Greenleaf, 1977; Joseph & Winston, 2005; Stone, Russell, & Patterson, 2004) compare common aspects of successful leadership styles. In conjunction with a leader’s role, discussion related to nurses understanding of belongingness at a staff level informs leadership practices. A focal point was on nurses perception of how belongingness influences a

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leader’s ability to create a caring atmosphere within nursing practice (Harvath, Swafford, Smith, & Miller, 2008; Kerfoot, 2005; Kleinman, 2004b; Lannon, 2007; Moody, Horton- Deutsch, & Pesut, 2007; Paton, 2007; Pearson, Laschinger, Porritt, & Jordon, 2007; Thorpe, 2008). Nature of the Current Study Overview of the Research Method A qualitative researcher, through a process of phenomenological inquiry, aims to discover the importance of the phenomenon through the context in which the participants act, and use this knowledge to influence future actions (Ehrich, 2008; Gadamer, 1976; Groenewald, 2004; Maxwell, 2005; Moustakas, 1994; van Manen, 1990). Unlike quantitative research, causal explanations are not the focus in qualitative research approaches; still, through exploring phenomena, qualitative researchers focusing on the question how and the process itself can make connections (Maxwell, 2005). Testing theory was not the intention of this current study. The aim was to explore, from participants ’ perspective, what belongingness means within the context of nursing practice, and to discover how nurse leaders might use new knowledge toward creating supportive and caring practice settings for nurses. The results of this current study support the need for nurse leaders to consider belongingness in increasing job satisfaction for nurses and improving retention rates. Overview of the Design Appropriateness Qualitative research from a phenomenological perspective, a common approach used in nursing studies, provides flexibility, and adaptability when exploring a phenomenon (Holroyd, 2001; van Manen, 1990). The interview questions, designed to

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find emerging themes and explore unexpected findings, reflected the intent of the research questions. Crucial in staying true to the research questions was continual reflection on data needed and how best to retrieve data while remaining open to new interpretations (Maxwell, 2005). Individual interviews continued until no further new themes emerged and saturation occurred. An encompassing term including an array of research approaches and philosophical movements, phenomenology takes place within the lived experience of participants (Finlay, 2008). Husserl, viewed as an originator of phenomenology, believed total objectivity by the researcher is essential in achieving understanding of a phenomenon (Ehrich, 2008; Vandenberg, 1997). Heidegger, a student of Husserl, believed significantly in the researcher being part of a participant’s space. In contrast to Husserl’s approach in separating self and consciousness, Heidegger believed separating self from the world detracts from knowledge acquisition when excluding personal experience (Ehrich, 2008). In essence, separation of self and consciousness does not reveal true interpretation of the phenomenon under study. Phenomenology, chosen as a method to explore belongingness within the lived experience of nurses in this current study, used van Manen’s (1990) approach to discover meaning and fully know oneself. A loss of belongingness in the practice setting as devaluing of nurses’ work continues, framed the need for exploring belongingness in work satisfaction, and as a possible influence for nurses leaving the profession. In the current work climate, nurses continue to bear the brunt of job losses and a lack of respect from patients and other health care providers. As workloads continue to increase, the loss

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of spirit as described by Dewey (1938) is escalating leaving a disgruntled and demoralized nursing workforce (Harvath et al., 2008). Exploring belongingness with colleagues is intriguing, as a phenomenological researcher does not separate self from the phenomenon under study. Bringing personal life experience to the current study enhanced understanding and interpretation of participants’ description of belongingness. Awareness of and declaring how personal knowledge influences participants’ lived experience prevented bias and misinterpretation of participants’ dialogue. In essence, prompting nurses to explore belongingness and reflect on how such knowledge could assist in the creation of caring and supportive work settings might persuade nurses to remain in practice. Merleau-Ponty (1962) further identified four themes common to phenomenology as reduction, intentionality, essences, and description. These four points emphasize phenomena as something described from the perspective of an individual’s experience based on the character being conscious or intentional about the subject of study from several perspectives. Weiss (1994) recommended selecting research participants intimately involved in the identified phenomenon. Participants in the current study, selected because living the experience provided insider knowledge, enhanced current understanding of the phenomenon. Directing the current study to a nurse’s viewpoint supports Weiss’ (1994) recommendation, as nurses in a position to describe belongingness from a personal perspective can comprehend what support nurses need to attain a work environment of belonging. Maxwell further (2005) described the strength of qualitative research as the focus on participants’ words rather than on numbers, emphasizing a qualitative approach

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was more appropriate than a quantitative method for this current study. Gathering data from a survey would not provide the rich information required for exploration within participants’ lived experience. Although a phenomenological approach encompasses many perspectives, the current study used van Manen’s (1990) hermeneutic or human science pedagogy approach. Hermeneutic phenomenology takes the lived experience of study participants and turns participants’ words into a textual representation (van Manen, 1990). The focus on research participants to be reflective, stimulating thinking of how belongingness influences nurse and nurse leader behavior, describes the essence of phenomenology as a powerful and evocative way to explore a phenomenon. Even though a hermeneutic approach does not have prescriptive steps in conducting phenomenological inquiry, van Manen (1990) suggested the use of several data sources including the researcher’s personal experience, interviews from study participants, and inclusion of literature to uphold valid analysis. Thematic analysis identified themes in three ways: holistically, selectively, and line by line. Intrinsic to van Manen’s hermeneutic approach is including anecdotal examples bringing to light lived experiences of participants. In staying true to a participant’s concept of a phenomenon, the researcher approached inquiry in an encouraging, rather than influencing, manner to draw out a participant’s response (Ehrich, 2008). Research Questions Titelman (1979) identified the importance of researcher experience and understanding of a phenomenon in achieving a common starting point for exploration with participants. As hermeneutic inquiry depends on a participant’s description of an

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experience, research questions and interview procedures must have an initial focus to engage a participant’s reflective discussion. Questions designed from a foundation based on theory, previous research, and researcher understanding of belongingness highlighted the issue and framed the current study (Maxwell, 2005; van Manen, 1990; Vincent & Mertz, 2006). Creswell and Plano Clark (2007) identified the importance of keeping an open mind during collection and interpretation of participants’ words. Gadamer (1976) described the process as a circle of data collection, analysis, correction of biases, and hearing what the text is saying. The practice of reflection was appropriate as nurses currently perform reflective processes, using new self-awareness to improve nursing care, and influenced the choice of hermeneutic inquiry in the current study (CNA, 2004). The following questions, designed to support reflective responses, encouraged nurses to think about work environments where nurses do or do not possess a sense of belongingness. The central questions in this current study were: 1. What is a nurses understanding of the term belongingness? 2. How could a nurse leader use the concept of belongingness in developing caring and supportive work environments? 3. How could belongingness influence job satisfaction and retention of nurses? Theoretical Framework Sociology and psychology theory formed the foundation for exploring belongingness from the perspective of human motivation. Baumeister (1982) initially explored the concept of self-presentation as a precursor to belongingness. Baumeister and Leary (1995) further studied belongingness based on a hierarchy of human desires, as

Full document contains 209 pages
Abstract: The purpose of this qualitative study, from a phenomenological approach, was to explore nurses' understanding of belongingness and the influence this knowledge could have for nurse leaders on job satisfaction and retention of nurses. Fifteen Registered Nurses (RNs) from a health care organization in Toronto, Canada, took part in the study. From the interviews conducted, holistic, selective, and line-by-line analysis of transcripts occurred. The use of NVivo 8 software during data analysis assisted in identifying themes. Four core themes emerged: Belongingness relates to possessing a feeling of happiness and a sense of family; creating belongingness is primarily the responsibility of nurse leaders; organizations have a responsibility for ensuring a culture of belongingness exists; for novice nurses to remain in practice acquiring a sense of belongingness is essential. Implications are nurse leaders and organizations must commit to creating environments where nurses hold a sense of belongingness. Recommendations include organizational reviews of current barriers to creating caring and supportive practice settings, and for nurse leaders at all levels of an organization to focus on the concept of belongingness in creating nursing practice environments conducive to retaining nurses.