A conceptual model of nurses’ workplace social capital: a theory synthesis

The healthcare industry is a complex and yet an adaptive system [1]. Nurses comprise the majority of healthcare professionals in any healthcare organization and weave their relational networks in their organizations through their interactions among themselves and with the other healthcare providers. These relational networks have been described as “workplace social capital” or “organizational social capital”. The global intensification of work-life and the importance of the quality of work environment on the workforce have put an unprecedented attention on workplace social capital [2].

Research portends the positive and promising influences of nurses’ workplace social capital [3, 4]. The value of findings from single studies is nil if the knowledge gained is not integrated into a network to present a more comprehensive understanding of the reported phenomenon [5, 6]. Despite extensive single studies on the concept of nurses’ workplace social capital, there is a lack of an evidence-based on its comprehensive presentation. A conceptual model (a graphic form of theory), that is based on the synthesis of previous work provides an effective way to depict and to develop a deeper understanding of the nurses’ workplace social capital [6].

The term “social capital” was originated from the domain of sociology and is regarded as an important element for organizational success through the networks of relationships [7]. Several social scientists have made significant contributions to the development of social capital; however, Bourdieu was the first who formally defined this concept in his 1986 publication entitled “The forms of capital”. He defined the concept of social capital as “the aggregate of the actual or potential resources which are linked to possession of a durable network of more or less institutionalized relationships of mutual acquaintance and recognition - or in other words, to membership in a group” [8]. About a decade later, Putnam introduced the notion of social capital to the field of empirical studies [9, 10]. Various dimensions with shared attributes have been proposed by scholars based on their interests in different facets of this phenomenon [11].

In the field of nursing, Read [12] first coined the term “nurses’ workplace social capital”.

Xu et al. [4] expanded on this concept to capture the contemporary changes, e.g. diversity in the demographic structure of the nursing workforce, or the assumption of more autonomy in the delivery of healthcare services by the nursing professionals. Meanwhile, several other nursing scholars have contributed to the development of social capital theories in the nursing profession. For instance, DiCicco-Bloom et al. (2007) constructed a “Social Capital Model” to facilitate understanding of the complex relationships in the operation of primary care work environment [1]. In 2013, Hofmeyer proposed a “Social Capital Framework”, with the objective of illustrating the importance of developing team relational networks in effective nursing management [13]. Gilbert et al. (2017) introduced the “Conceptual Model of Organizational Intellectual Capital”; this conceptual model further cements the vital position of social capital in nursing leadership [14]. Development of these theories and conceptual models of social capital in the nursing field mostly have been based either on resources borrowed from outside disciplines or limited nursing insights. Research supports the considerable influence of nurses’ workplace social capital on nurses’ mental and physical well-being, quality and efficiency of patient management and the overall healthcare organizations [4, 15‐17]. Yet, so far, no theoretical model rooted in the integrative evidence of nursing studies that addresses workplace social capital has been developed. The aim of this paper is to report on the development of an evidence-based conceptual model of nurses’ workplace social capital, grounded on a logical theory synthesis approach, which can be implemented as a practical framework for future research and practice.

The approach adopted to developing this model is based on the theory synthesis proposed by Walker and Avant [6]. This strategy enables to transform the results of empirical studies about a phenomenon of interest into an integrated whole; in other words, it brings the pieces of knowledge together in a logical way to form a more useful and coherent presentation. It is considered a step beyond the concept analysis and a specified approach for development of a theory. The process of theory synthesis consists of three iterative steps: specifying the focal concept(s), identifying factors related to the focal concept(s) and their relationships, and constructing an integrated presentation [6].

Theory synthesis is grounded in empirical evidence. In this paper, literature served as the source for synthesis of the theory in which the notion of nurses’ workplace social capita was grounded. The databases of PubMed, CINAHL, Web of Science and Google Scholar platform were searched, without time limitation, to identify relevant publications. Search strategies were developed based on the combinations of search terms “social capital”, “nursing”, “nurses” and “nurs*” with proper Boolean operators. For example, the strategy that was implemented in searching the PubMed consisted of the following steps: 1) # 1: social capital [MeSH] OR “social capital” [Title/Abstract]; 2) # 2: nursing [MeSH] OR nurses [MeSH] OR nurs* [Title/Abstract]; and 3) #3: # 1 AND # 2.

The initial search was conducted in October 2017 and the literature was periodically reviewed to capture the most current information. The final search, conducted in July 2020, was limited to full-text English articles in peer-reviewed journals. A total of 179 articles in PubMed, 506 in CINAHL, 185 in Web of Science and 75 in Google Scholar were identified and downloaded into the EndNote (version X8), and in consequence, 84 duplicate articles were eliminated. The remaining 861 retrieved publications were scanned by their titles and abstracts and studies were excluded (n = 524) if their objectives and/or scopes had excluded the concept of social capital. The remaining 337 articles then were reviewed for their contexts. Commentary papers and studies relevant to patients’ or nursing students’ social capital and social capital in scientific domains other than the nursing field were further excluded in this step. A total of 29 articles discussing quantitative, qualitative, and theoretical aspects of nurses’ workplace social capital were selected to draw evidence for the development of the model. Finally, the PhD dissertation work of the lead author exploring factors influencing nurses’ workplace social capital was included in the evidence pool of empirical research [6, 18]. The characteristics of the included studies are provided in Table 1.

Assumptions are beliefs about a phenomenon or an event acting as a premise to understand a theory [5]. The four assumptions that were the pillars of our work in knowledge synthesizing and model construction of the nurses’ workplace social capital theory are: 1) The essentiality of and the necessity for a comprehensive understanding of this phenomenon before interventions; 2) The necessity of a comprehensive understanding of the constitution of nurses’ workplace social capital itself, the potential determinants for its occurrence and the ensuing outcomes; 3) A conceptual model with a graphic display, supported by empirical evidences, can help to produce a compact representation of a phenomenon which could enable to form a framework for future investigations and practical applications; and 4) The necessity for a continuous evaluation of nurses’ workplace social capital to propel the evolution of the model in response to the rapid changes in the profession of nursing.

We conducted a theoretical synthesis by Walker and Avant [6] and developed a theoretical model to amalgamate the current separated knowledge about nurses’ workplace social capital pillared by four theoretical assumptions. Our conceptual model depicts the constitution (attributes and classification), determinants (organizational and individual factors summarized from lower-level variables) and outcomes relevant to nurses, patients, and organizations. These outcomes have been collapsed into 18 less general outcomes and arranged into four distinct but interrelated blocks. Finally, the proposed five propositions among these blocks are supported by research evidence [1, 3, 4, 7, 15, 16, 19‐37].

Nursing is a distinct science and nursing is a sovereign healthcare profession. It behooves the nursing profession and the nursing professionals to derive theories from the nursing domain [5, 6, 47]. Our conceptual model was synthesized on the premises of the nursing science and literature which contrasts with the previously developed theoretical models [1, 13, 14]. For example, the Social Capital Model by DiCicco-Bloom et al. [1], or the Social Capital Framework by Hofmeyer [13] or Gilbert Conceptual Model of Organizational Intellectual Capital [14] were developed based on literature sources from professions outside nursing or incorporated limited nursing research evidence. Application of these models in the nursing work environment might be hindered due to these limitations [14].

Our model was founded on previously developed models by nursing scholars [15, 30, 32]. These models were developed by applying statistical procedures such as path analysis or structural equation modeling to investigate the relationships between social capital and several independent variables and effect modifiers; the pertinent results of these studies have been used as the support for the current theory synthesis. To our knowledge, this newly synthesized model is the first conceptual model grounded in the integrative nursing evidence and follows the logical approach of theory synthesis [6].

A conceptual model can be applied in research, practice, and teaching in nursing science [5, 6, 14]. This synthesized model may point some clues for further research; for example, other potential determinants may be explored through both quantitative and qualitative investigations, especially for nurses’ individual factors. Or new concepts and statements could be entered into the conceptual model with further development of this theory and accumulation of more evidences. The other venues for advancing research in this arena include: 1) Assessment of interactional effects of the two categories of determinants on the focal concept. 2) Further assessment of the mediators between the determinants and nurses’ workplace social capital; more attention may be added to mediators and moderators between related variables and nurses’ workplace social capital; and 3) Implementation of longitudinal and interventional research to confirm the causal relationships among the focal concepts and outcomes.

Our conceptual model also can be applied in nursing practice. When seeking to improve the relevant outcomes in the healthcare organization, nursing administrators could try to achieve their goals through interventional programs on nurses’ workplace social capital with consideration of the determinants listed in this model. Meanwhile, the compromising outcome of social exclusion among the nursing workforce should be noted. However, an appropriate level of bonding may increase “togetherness” among group members [38]. The balance between restricting and formulating bonding social capital among nurses needs further exploration [4]. Additionally, our model also is conducive to teaching programs for nursing students and clinical nurses. The concept of workplace social capital is a subjective and abstract concept [4, 12, 14]; therefore, it is not easy to illustrate and understand its whole realm which involves the constitution of the construct, its related concepts, and the interrelationships among them. Our proposed summarized conceptual model with graphic and linguistic presentations makes the process of teaching and learning more manageable.

The process of developing our conceptual model has some limitations. First, the literature search was restricted to English language, peer-reviewed journal articles. Thereby, some information about nurses’ workplace social capital could have been missed. Second, the hypothesized interactional relationships (marked by the double arrow line in the model) need empirical confirmation. Despite the limitations of our manuscript, our work is the segue to future research and new findings and could provide new insights into the theory construction of nurses’ workplace social capital.

In recent years, the precipitous attention of nursing scholars and researchers to nurses’ workplace social capital has made it necessary to capture a comprehensive insight into this phenomenon. Our newly synthesized conceptual model provides an effective way of approaching this goal. The strategy used for developing our conceptual model of nurses’ workplace social capital is the theory synthesis proposed and developed by Walker and Avant [6]. Our proposed model can be used as a foundation for further research based on identified gaps of current knowledge in the literature and the proposed propositions. Nursing practices that aim to strengthen nurses’ workplace social capital can consider the identified determinants. More studies are required to continuously enrich the current pool of evidences to address complexity of this conceptual model [6]. New knowledge should be integrated into our proposed model based on the evidence from model testing and the expansion of empirical investigations.