Assimilating to Hierarchical Culture: A Grounded Theory Study on Communication among Clinical Nurses

Abstract

The purpose of this study was to generate a substantive model that accounts for the explanatory social processes of communication in which nurses were engaged in clinical settings in Korea. Grounded theory methodology was used in this study. A total of 15 clinical nurses participated in the in-depth interviews. “Assimilating to the hierarchical culture” emerged as the basic social process of communication in which the participants engaged in their work environments. To adapt to the cultures of their assigned wards, the nurses learned to be silent and engaged in their assimilation into the established hierarchy. The process of assimilation consisted of three phases based on the major goals that nurses worked to achieve: getting to know about unspoken rules, persevering within the culture, and acting as senior nurse. Seven strategies and actions utilized to achieve the major tasks emerged as subcategories, including receiving strong disapproval, learning by observing, going silent, finding out what is acceptable, minimizing distress, taking advantages as senior nurse, and taking responsibilities as senior nurse. The findings identified how the pattern of communication in nursing organizations affected the way in which nurses were assimilated into organizational culture, from individual nurses’ perspectives. In order to improve the rigid working atmosphere and culture in nursing organizations and increase members’ satisfaction with work and quality of life, managers and staff nurses need training that focuses on effective communication and encouraging peer opinion-sharing within horizontal relationships. Moreover, organization-level support should be provided to create an environment that encourages free expression.

Factors influencing the implementation of evidence in Chinese nursing practice

“…However, this study also extended the results of previous studies by further exploring the blurred boundaries between facilitators and barriers, influences from Chinese cultural impact and project leaders' roles, as well as an emphasis on the importance of point of care in evidence-based nursing. Second, this study showed a profound influence by the Chinese cultural values, which is characterised as assimilating to the system's culture and seeking harmony, following the power hierarchy and obedience to authority (Delury, 2008;Farh & Cheng, 2000;Kim & Oh, 2016;Lee, Hsu, Li, & Sloan, 2013). These intraconnected cultural values work interactively behind the scenes of Chinese evidencebased nursing practice .…”

“…Second, this study showed a profound influence by the Chinese cultural values, which is characterised as assimilating to the system's culture and seeking harmony, following the power hierarchy and obedience to authority (Delury, ; Farh & Cheng, ; Kim & Oh, ; Lee, Hsu, Li, & Sloan, ). These intraconnected cultural values work interactively behind the scenes of Chinese evidence‐based nursing practice (Cheng et al., ).…”

Factors influencing nurses' intention to care for patients with emerging infectious diseases: Application of the theory of planned behavior

“…Thus, it would be effective to encourage nurses to decide to provide patient care voluntarily to increase willingness to care for patients with EID. However, this might be challenging because of the vertical organizational structure in Korean nursing, and this hierarchical culture has made it difficult for Korean nurses to speak out (Kim & Oh, ). The majority of Korean nurses could not refuse instructions from their superiors or nurse managers when asked to care for MERS patients during the outbreak (Kim, ).…”

“…However, this might be challenging because of the vertical organizational structure in Korean nursing, and this hierarchical culture has made it difficult for Korean nurses to speak out (Kim & Oh, 2016).…”

ENN-RICH: (Engaging Novice Nurses Through Reflecting and Interactive Coaching Huddle)

“…The variable on "displaying positive disposition in sharing views and opinions" receiving the lowest score may be attributed to the findings in a study done in South Korea that novice nurses preferred "peer opinion-sharing within horizontal relationships" [37]. Since coaching is done by their seniors, this aspect of the RICH strategy was not fully appreciated by novice nurses.…”