The largest proportion of participants were aged 40 to 49 years. Furthermore, 31% had more than 10 years of service in public health units, 23.4% had between 5 and 10 years, and 28.4% had less than 5 years. Approximately 60% of participants had a bachelor’s degree. These findings indicate that nursing staff in public health services should be equipped with sufficient field experience to be familiar with conditions in the local community and able to establish partnerships (Polivka et al., 2008). Approximately 40% of the participants did not have a bachelor’s degree, which may result in a relatively weak perception of empowerment among the PHNs, both psychologically and concerning the working environment (Chang & Liu, 2008; Chang et al., 2008).
CCNC comprises three dimensions: CC, communication, and management. Communication items displayed the highest scores, indicating that PHNs should be equipped with strong communication competencies because these enable them to establish nurse–patient relationships and understand clients concerns when providing care plans; this finding accorded with results reported in the literature (Bigbee et al., 2010; Clark et al., 2016; Siemon et al., 2018).
The CC results indicated that health checks and early screenings of related chronic diseases were the services most commonly provided by PHNs, suggesting that the PHNs’ care services were primarily focused on preventive health services. Studies have reported that PHNs provide services for community health promotion and preventive care services and that the frequency of providing chronic disease care services is the highest (Bigbee et al., 2010; Cole et al., 2011; Bing-Jonsson et al., 2016). However, the participants reported that their competencies were insufficient when providing individual care plans based on client needs and preventing comorbidities, which may be related to PHNs’ experience in the care of disease (Clark et al., 2016; Edmonds, et al., 2017). When the COVID-19 pandemic occurred in 2020, communities faced a tremendous public health threat. Therefore, PHNs should exercise caution when visiting clients in the community and increase their relevant knowledge of emerging infectious disease and prevention measures. Furthermore, PHNs should also instruct the public on disease prevention and provide referrals to competent professionals to control hazardous public health situations (Cole et al., 2011; Bing-Jonsson et al., 2016).
The care management model in communities is currently a top–down model, which prioritizes client compliance and ignores their autonomy. Furthermore, PHNs often abide by existing health education brochure content instead of considering the clients’ lifestyles and needs, which inhibits PHNs from providing clients with in-depth and long-term chronic disease management (Flowers et al., 2020).
Assessment of the health risks and impacts of health-related cultural beliefs and practice is considered the competence to promote health and prevent diseases. Nurses may provide health education on the social and behavioral factors that affect the health of individuals and groups. Furthermore, strategies are employed to promote behavioral changes.
In terms of “Communication,” PHNs could “Maintain effective communication with the client and listen and accept client concerns,” “Provide the clients with proper explanations and descriptions when implementing related measures or care plans,” and “Observe and use nonverbal communication skills to establish high-quality nurse–patient relationships,” indicating that communication plays a crucial role in CC services. The results of this study demonstrated that communication competence affects nurses’ perception of empowerment, a finding which accords with findings in the literature (Clark et al., 2016; Bing-Jonsson et al., 2016). However, the nurses perceived personal insufficiencies in the items of “Make decisions concerning treatment and care plans with community clients” and “Use community resources to achieve various treatments or health promotion,” demonstrating that nurses must improve communication with the clients regarding their needs when discussing care plans (Bigbee et al., 2010; Chang et al., 2008).
For “Management” in the community, “Cooperate with central government policies to implement chronic disease–related care” and “Cooperate with the organizational departments (such as long-term care and social welfare)” were the most critical, demonstrating that nurses must adhere to health care policies when promoting public health by professional contacts and discussion of CC services among chronic disease care businesses and relevant units of long-term care and social welfare institutions. However, most participants reported that “Implementing the evaluation and modification of case care” was difficult in managing chronic disease cases, which could be related to the accumulation of practical experience in the community or work overload. PHNs understood that developing community ability by using community-oriented programs is the most important core concept (meaning). However, such effort requires more time than individual public health services (MacDonald & Schoenfeld, 2003).
The CE results indicated that the PHNs believed that “The work that is performed is critical for health promotion” and “The work that is performed is crucial in promoting community health,” and these beliefs were associated with psychological empowerment. Regarding organizational empowerment, the participants with a self-perception of “I can meet the work requirements and complete the work as scheduled” could also perceive that they were empowered in the workplace, which improved their work efficiency (Flowers et al., 2020).
The results of this study indicated that access to organizational information had a positive impact on community competence. These results accorded with previous studies. PHNs are better equipped to understand the needs and the goals of the organization when they have more information, which can improve work efficiency. This result supported the premise of the cognitive model of empowerment and accorded with studies that stated that employees with stronger self-efficacy would make more efforts to cope with the challenges of client outcomes and would feel more effective in their work (Piper, 2011; Royer, 2011; Flowers et al., 2020).
A significant positive correlation was observed between the degree of chronic disease care implementation and the perception of empowerment, indicating that more frequently performing CC was associated with a higher score on relative empowerment perception, which accords with results from numerous studies, including a study on empowering PHNs in the care of clients and improving PHNs’ self-efficacy (Royer, 2011; Cole, 2011; Clark et al., 2016), a study on the effect of psychological empowerment on CC competence (Chang et al., 2008), and a study on the positive effects of self-efficacy on work performance (Chang & Liu, 2008; Piper, 2011). The results of the present study indicated that PHNs’ competence in the implementation of CC management and the degree of implementation increased when their perception of psychological empowerment and empowerment in the workplace was enhanced.
Chang et al. (2008) suggested that psychological empowerment could be encouraged and promoted through education and training and by sharing work experience within groups. They further suggested that supervisors could have active discussions with nurses to provide them the opportunity to participate in the decision-making process, which could enhance their influence at work. Furthermore, the World Health Organization (WHO) mentioned that for the innovative care of chronic diseases, community-related care management and innovative measures are being developed in the world and include education, self-management training, and the provision of services by community volunteers and nonprofessional personnel in the community (WHO, 2020). Empowering PHNs can enable them to use this experience to empower clients with chronic diseases to achieve the ultimate ideal state of CC.
Certain aspects of psychological empowerment, such as the sense of self-meaning of work, care management competence, and decision-making related participation, can be enhanced with related resources, such as more work-related information, specific suggestions for information, addressing problems, and positive encouragement, all of which can enable PHNs to be independent and able to leverage all community resources to manage chronic diseases. PHNs would thus be able to provide patients and their family members with relevant chronic disease care information to address their concerns and implement strategies with partner organizations to improve the quality of care for clients with chronic disease in the community.
CE reflects the continuous shifts in power relations between different individuals and social groups, whereas empowerment, in the broadest sense, refers to the process by which people with less power work together to increase control over events that could determine their lives and health. The combination of organizational and psychological aspects of employee empowerment can be understood as a cognitive state in which power-sharing, competence, and value internalization in an organization can be experienced. Public nursing activities include cooperation in communities, health education, and policy development to manage priorities, which are decided through a continuous and comprehensive people-oriented assessment. PHNs are professionals from interprofessional teams and organizations (including different levels of government, communities, nongovernmental organizations, foundations, policy think tanks, academic institutions, and other research institutes).
Professional competence is crucial in providing quality health care services. Quality of care requires that nursing staff members possess the competencies needed to satisfy complex health care demands. Internationally, studies have indicated that higher staffing a higher number of nurses in general health care are associated with a higher quality of care, improved patient outcomes, and fewer adverse events.