INTRODUCTION:

A network refers to the connection of components interconnected in a social organizational structure¹. A network in an organization is the connection relation that is connected with the members in the organization that is produced and maintained through contact with the members, and at the same time is based on the social network theory, in which the network structure affects the behavior of individuals. This theory began in the early 1930s in the three disciplines of psychology, anthropology, and mathematics, and has since been applied to various fields such as business administration, anthropology, political science, and psychology². This content is used as a theoretical concept and tool to connect the relationship between individual behavior and social structure as a basis for explaining the behavior of the members^1,3.

Social network analysis is a quantitative analysis method that quantitatively examines the interactions among actors in a group and shows how a particular type of information exchange or opinion exchange connects individual actors¹. In social network analysis, actors are represented by dots, where the connections between dots indicate the direction of the relationship, and the characteristics of actors are explained by the actor's position, distance, and frequency of relationship⁴. Centrality is an indicator of the location and characteristics of the actor. The centrality indicates the person who is in the center of the network and identifies important actors, and it is divided into degree centrality, closeness centrality, and between’s centrality. Degree centrality is a measure of the degree to which an actor is located at the center of a network through how much of an actor is related to other actors, and is obtained as the sum of actors directly connected to one actor⁵.Closeness centrality is measured as the proximity to other points or the shortest distance connecting two points, and is used to take into account the overall relationship of the network. Between’s centrality is the degree to which a point is located between different points within a network, and is used to understand the degree of mediator role in the network. Density refers to the ratio of actual connected paths among the possible paths that can be linked, and refers to the degree of cohesion among people who know each other or are connected to each other in the network⁶. The members of the group share their inner world emotionally through group cohesion and experience acceptance by others, and through this, the members gain group spirit that is stronger than unity, teamwork, and solidarity as a group⁷.

Studies on the networks in organizations using social network analysis method include the study on informal networksinorganizations⁸, the study of social network analysis approach to the effects of diversity and performance within a team⁹, the study on the effect of department centralization on job stress factors and job satisfaction in organizational network¹⁰, the study on informal network analysis of touring lifelong education teachers¹¹, and the study on the perception of communication network and organizational atmosphere for US police organizations¹². These studies argue that the nature of the network affects organizational performance improvement and that utilization of information in the network can help to establish a human resource development strategy that fits the organizational context or purpose. However, in the aspect of nursing human resource management in hospitals, studies on analyzing the personal behavior in a group in connection with the structural and social characteristics was relatively inactive. For this, the purpose of this study is to find out the context of work and organization by analyzing the relationship among members through invisible communication patterns for hospital nurses and to lay the basis for human resource management.

2. MATERIALS AND METHODS:

2.1. Study design:

The present study was a descriptive study designed to examine the centrality of nursing staffs and the density of nursing units.

2.2. Participants:

The participants were 243 nurses working in the general unit (GU), emergency room(ER), intensive care unit (ICU), and operating room (OR) from 2 general hospitals. The survey was voluntary and anonymous for the respondents. The cover letter provided information regarding the study, explaining the aims, methods and a consent form. The nurses who participated in the study were included staff nurses and charge nurses and chief nurses were excluded.

2.3. Instruments:

Peer nomination by Moreno¹³was used to inform networks among nursing staffs at a nursing unit.

2.4. Statistical analysis:

The collected data were analyzed using UCINET 6.0 and SPSS 22.0.

1) For the centrality of nursing staffs and density of nursing units, social network analysis was used.

2) For the difference in centrality by the demographic characteristics of nursing staffs, t-test and ANOVA were used.

3) For the difference in density by the types of nursing units, ANOVA was used.

3. RESULTS AND DISCUSSION:

3.1. Centrality by the demographic characteristics:

The general characteristics of the staff nurses who participated in the present study are shown in Table 1. Female were 224(92.2%) nurses, and male were19 (7.8%) nurses. The age group ranged from 21 to 49 years old.83 (34.1%) nurses were the 21-24 age group, 109(44.9%) nurses were the 25-29 age group, and 51(21%) nurses were over 30 years old. Less than 2 years working on current ward was 137(56.4%), 2-5 years working on current ward was 78(32.1%), and more than 5 years was 28(11.5%). The three shift was 187(77%), two shift was 4(1.6%), and fixed was 52(21.4%). There was not a significant difference in gender and age, but there was a significant difference in years worked as a nursing staff on current unit and pattern of shift.

Table 1:Centrality by the demographic characteristics (N=243)

N (%)

Degree

Closeness

Betweenness

M(SD)

F/t(p)

M(SD)

F/t(p)

M(SD)

F/t(p)

Gender

Female

Male

224(92.2)

19(7.8)

0.22

(0.15)

0.16

(0.11)

1.801

(.073)

0.29

(0.16)

0.25

(0.09)

0.854

(.394)

0.05

(0.07)

0.05

(0.07)

0.448

(.654)

Age (yr)

21-24

25-29

≥30

83(34.1)

109(44.9)

51(21)

0.20

(0.14)

0.22

(0.15)

0.25

(0.15)

0.177

(.172)

0.27

(0.17)

0.29

(0.15)

0.26

(0.13)

0.483

(.617)

0.05

(0.08)

0.06

(0.07)

0.05

(0.06)

0.529

(.590)

Years worked as a nursing staff on current unit

≥2

<2≤ 5

137(56.4)

78(32.1)

28(11.5)

0.20

(0.14)_a

0.23

(0.15)_b

0.28

(0.17)_c

3.509

(.031)

a<c

0.25

(0.15)_a

0.29

(0.15)_b

0.35

(0.15)_c

4.931

(.008)

a<c

0.05

(0.07)

0.05

(0.06)

0.08

(0.09)

2.026

(.134)

Pattern of shift

3shifts

2shifts

Fixed

187(77)

4(1.6)

52(21.4)

0.24

(0.15)_a

0.38

(0.14)_b

0.14

(0.08)_c

11.356

(.000)

c<a

0.27

(0.16)

0.37

(0.17)

0.29

(0.12)

1.211

(.300)

0.06

(0.08)

0.06

(0.05)

0.04

(0.06)

0.802

(.450)

3.2. The density of nursing units by the types of units:

This study includes 2 general hospitals. The general units are 12, the emergency rooms are 2, the intensive care unitsare 2, and the operating rooms are 2.Density of the general units ranged from 0.06 to 0.41 with a mean of 0.21. Density of the emergency rooms ranged from 0.26 to 0.37 with a mean of 0.32. Density of the intensive care units ranged from 0.19 to 0.40 with a mean of 0.30. Density of the operating rooms ranged from 0.05 to 0.41 with a mean of 0.12. There was not a significant difference in density by the types of units as seen in table 2.

Table 2: Density by the types of units (N=18)

Range

M(SD)

F(p)

ICU

0.06-0.41

0.26-0.37

0.19-0.40

0.05-0.41

0.21(0.11)

0.32(0.08)

0.30(0.15)

0.12(0.10)

1.369

(.293)

3.3. DISCUSSION:

In this study, the characteristics of social network according to the general characteristics of nurses did not differ according to gender. The most representative study of gender differences in the network by Ibarra¹⁴ found that while men get information and social support from the same gender, women get social support from women and job information from the network with men, showing that there is a difference in network depending on gender. Although it is thought that there was no difference in the characteristics of the network according to gender since most of the subjects of this study were female, if it is possible to reveal the difference of the form of network according to gender through repeated research, it will be possible to use as a basis for human resource management. Also, there was a significant difference in degree centrality and closeness centrality according to clinical career of current department. More than five years of clinical experience in the current department showed more centrality than less than two years, which can be interpreted as an individual having the greatest impact on others when they have been in a group for more than five years. This means that, when one is assigned to a new nursing unit for less than two years one will have to adapt to the new environment and work, and because is time to build new relationships with colleagues who one has not known before, it is considered that the time is not enough to form intimate relationship that influences others. In addition, it is determined that, with clinical career of more than 5 years, experience is built and work capacity and competence are improved, so there is enough room to be interested in the surrounding environment, and as the age naturally increases, the individual becomes better at forming and maintaining relationships with others. Based on these results, it can be said that it is necessary to appropriately allocate nurses who have more than 5 years of experience with high degree centrality to each nursing unit. In addition, three shift nurses had higher degree centrality than fixed workers, which can be interpreted that that nurses working in three shifts are more likely to meet other nurses in the nursing unit than those who work in fixed shifts, which means interaction is active and has more influence.

In this study, cohesion was not different according to the types of nursing units.Ko¹⁵ has reported a different result that group cohesion for nurses in special wards significantly higher than for nurses in general wards. Other participants and data collection may have different results. The participants of the study conducted by Ko¹⁵included not only staff nurses but also charge nurses and chief nurses and used group environment questionnaire to collect data. However, this study only included staff nurses and used peer nomination to collect data. Mean while, cohesion was found at various levels according to nursing units in the studies using social network analysis method. In this study, the density of the general units was 0.06-0.41, the emergency room was 0.26-0.37, the intensive care units was 0.19- 0.40, and the operating room was 0.05-0.41.Comparing with the density of other organizations, the density of the communication network was 0.44-0.69 and the density of the advice network was 0.20-0.38 in van Beek et al's¹⁶ study of nursing homes and residential homes in 35 nursing units and 474 nurses. In Jang and Barnett 's study of 94 members of police organizations in the United States, the density was 0.58, and the density was 0.38 in Lee’s¹¹ study of 24 touring lifelong education teachers. This difference is a result of the fact that the cohesion can be different depending on the characteristics of the research subjects and the characteristics of the groups to which the research subjects belong. A ward nurse works in three shifts to nurse the patient who is in the hospital for 24 hours, and it is essential to communicate among the members, such as communicating the patient status during the working hours to the next working hours. An operating room is a place to treat the patient's body tissues surgically under anesthesia, which means there is almost no contact with the inpatient such as the patient or the caregiver, and a close relationship with the operation team is required. The intensive care unit conducts care by applying various special devices to the patient or his/ her family because the patient's condition is serious, and it is necessary to have close communication skills with doctors and fellow nurses in various medical fields related to the severe patient conditions. On the other hand, since the emergency room is a place where emergency patients from various accident sites are gathered, they will be involved in work related to 119 paramedics and police as well as emergency patients and family. In this way, it can be interpreted that the cohesion within the department is varied because the nurses are different from each other in terms of the working people who interact with each other according to their working characteristics. However, in order to improve the cohesion in the group, it is necessary to identify another cause of the difference of cohesion through repeated research, and for this purpose, it is necessary to deeply analyze the relationship between members through interviews on nurses in nursing units with significantly lower cohesion and nurses in nursing units with significantly higher cohesion.

4. CONCLUSION:

This study was conducted to investigate the network structure of nursing units by applying social network analysis method to nursing units and to attempt an organizational approach for nursing human resources management. In the study, while the social network characteristics of nursing units showed no difference according to gender, age, nursing unit type, more than 5 years of experience in the current department was linked to higher degree centrality and closeness centrality, and degree centrality of three shift workers was higher than that of fixed workers. This study is a basic research study exploring the network structure of domestic nursing units. It is necessary to generalize the social network characteristics of nursing organization through repeated research to establish practical basis for nursing human resources management, and it is considered that further research is needed to explore the practical effects.

5. ACKNOWLEDGMENT:

Author would like to thank all the nurses who participated in this study.

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Received on 30.06.2017 Modified on 07.08.2017

Research J. Pharm. and Tech. 2017; 10(9): 3081-3084.

DOI: 10.5958/0974-360X.2017.00546.7

Characteristics of Networks in Nursing Units