vol 1 issue 1.cdr - health professions educator journal

ISSN NO: 2663-1245 (Print)

Faculty of Allied

VOL 01 ISSUE 01 JAN-MAR 2017

About The Journal

playing multi-faceted roles than the past; to fortify novelty of work and instrumental to the knowledge.Lahore School of Nursing (LSN) The University of Lahore, is publishing its esteemed journal with the name of“Pakistan Journal of Nursing and Midwifery (PJNM), which is a quarterly peer- reviewed open access journal. The purpose of the journal is to provide a standard platform to share the knowledge, and innovative ideas for updating and advancement in nursing profession to keep pace with the modern world.

PJNM accept following research script for publication

Original Articles

Short communications

Case study

Review articles

Research script can be sent at the following addresses for review and publication

Prof. Dr. Syed Amir Gilani (Editor in Chief)

Mr. Muhammad Afzal (Editor)

Ms. Sana Sehar (Editor)

Mr. Muhammad Hussain (Editor)

[email protected]

The comments and suggestions (acceptance/ rejection/ amendments in manuscript) received from reviewers are conveyed to the corresponding author. The author is required to provide a point by point response to reviewer comments and submit a revised version of the manuscript. This process is repeated till reviewers and editors are satised with the quality of manuscript.

We are breathing in the age of Information and Technology where variant disciplines are


Pakistan Journal of Nursing and MidwiferyLahore School of NursingThe University Of Lahore,Lahore Pakistan

Electronic Version

The Electronic version of this issue of Pakistan Journal of Nursing and Midwifery, the university of Lahore can be accessed at http://journals.uol.edu.pk/ajahs

Publication Ofce

Mr. Muhammad Afzal Associate Professor / Principal

Editor

Pakistan Journal of Nursing and MidwiferyLahore School Of NursingThe University Of LahoreLahore Pakistan

Disclaimer

All article published represents the view of the author and do not reect any ofcial policy of the Pakistan Journal of Nursing and Midwifery. All the copy rights are reserved with PJNM, no part of the journal may be reproduce by any form or any mean without written permission from the editor in chief.


Instruction to the Authors and Reviewers of the ManuscriptsPakistan Journal of Nursing and Midwifery (PJNM)

(In accordance with the minimum requirement for the writing and editing of manuscriptssubmitted to the journals international committee)

IntroductionThe Editorial board of Pakistan Journal of Nursing and Midwifery (PJNM) held on October 6, 2017 and decided to designate the concord requisite for manuscript submitted to Biomedical journal: writing and editing for Biomedical Publication updated in 2006 by International Committee of Medical journal Editors (ICMJE). A brief account of minimum requirements is given below for assisting authors, reviewers and e d i t o r s , t h e f u l l t e x t c a n b e r e a d a t www.icmje,org.

Guide for AuthorsYou may choose to submit your manuscript as a single Word or PDF le to be used for submission process. After that only paper is at the revision stage, where it is requested to put your paper into a 'correct format' for acceptance and provide the items required for the publication of your article. Submissions will be peer-reviewed by eminent professional nurses of diverse backgrounds. Acceptance will be based on the importance of the material for the audience and the quality of the material. Final decisions about publication will be made by the Editor. We now differentiate between the requirements for new and revised submissions.

Scope of JournalThe Journal “Pakistan Journal of Nursing and Midwifery” will accept articles that focus on baccalaureate and higher degree studies in the elds of nursing management, clinical practice, and nursing research including the specialties of adult, pediatric, geriatric, and midwifery. Reports of original work, research, reviews, insightful descriptions, and policy papers focusing on baccalaureate and graduate nursing education will be published.

MANUSCRIPT CATEGORIES AND REQUIREMENTS

I. Original ArticlesPilot studies are not suitable for publication as original articles.Word limit: 8,000 words maximum (quotations are included in the overall word count of articles, and abstract, references, tables and gures are excluded).

ii. Review ArticlesLiterature reviews on any area of research relevant to nursing education, clinical practice and research.Word limit: 8,000 words maximum.

iii. Discursive ArticlesA discursive article (a piece of argumentative/ analytical writing) aim to explore opposing sides of an argument and put forward conclusion regarding the validity and accuracy of one arguments over the other. Word limit: 8,000 words maximum.

iv. Special Issue ArticlesAuthors interested in submitting a paper for a forthcoming special issue must contact the editorial ofce for discussion and submission of the paper within the category of Special Issue Guest Editor.

Types of ArticlesOriginal contributions that have never been published and are not under simultaneous consideration by another publication may be submitted.

Letters to EditorLetters to the Editor are published at the Editor's discretion. They will be subject to editing. The useof several references is permissible. A transmittal letter containing copy right assignment should accompany the Letter to the Editor. The Letter to the Editor it self should be typed and double-spaced, with the word limit upto 500.

Guidelines of Research Article Write-up


Body of TextBody of the text should include the following of introduction, methodology, result, discussion

IntroductionThe introduction should be designed to create interest in the reader about the topic and proposal. It should convey to the reader, what you want to do, what necessitates the study andyour passion for the topic.Some questions that can be used to assess the signicance of the study are:

1. Abstract

2. Introduction

3. Literature review

4. Methodology

5. Result

6. Discussion

7. References

Introduction This section is a brief summary of

the background of the study. It may consist of three short sentences, with the rst sentence specically mentioning the core content, the second its context i.e. the background and the third addressing the objectives of the research.

MethodsIn this section, you should state the methods that were used to answer the research questions. Three to four sentences should express the research design; the study population; the subject selection process; and the instruments, measurement tools, and statistical techniques, study population sampling methods, and the setting that were used.

ResultsThis section must describe major ndings of the study. This section should clearly dene the primary outcome of research and the key information provided in the article e.g., condence intervals, P-values, odds ratios, relative risks, and effect sizes within 5-6 lines only.

ConclusionThis section should contains important, and major ndings and their implications should be included. Recommendations are supported fully by the ndings of the research.

(I) Who has an interest in the domain of inquiry?(ii) What do we already know about the topic?(iii) What has not been answered adequately in previous research and practice?(iv) How will this research add to knowledge, practice and policy in this area? (v) If hypothesis cannot be constructed, the line of inquiry to be used in the research must be indicated.

It is crucial to structure this section intelligently so that the reader can grasp the argument related to study in relation to that of other researchers, while still demonstrating that work is original and innovative. It is preferable to summarize each article in a paragraph, highlighting the details pertinent tothe topic of interest. The progression of review can move from the more general to the more focused studies, or a historical progression can be used to develop the literature review. Five 'C's may be kept in mind while writing a literature review

ABSTRACT

The write up of article should include the following headings


Methodology This section starts with the aims and objectives of the research followed by following I. Research design and methodThe objective here is to convince the reader that the overall research design and methods of analysis will correctly address the research problem and to impress upon the reader that the methodology/sources chosen are appropriate for the specic topic. The components of this section include the following:i. Population and sampleii. Inclusion and exclusion criteria iii. Study Settingiv. Data collection techniquev. Tool validity and reliability (if any)vi. Rigor (soundness of the research)vii. Ethical considerationsviii. Budget

Result The function of the results section is to objectively present key results, with interpretation, in an orderly and logical sequence using both text and illustrative materials (Tables and Figures). The results section always begins with text, reporting the key results and referring to gures and tables

and summaries of the statistical analyses. Results section should be organized around tables and gures that should be sequenced to present your key ndings in a logical order. The text of the results section should be crafted to follow this sequence and highlight the evidence needed to answer the questions/hypotheses investigated. Important negative results should be reported equally. Write the text of the results section concisely and objectively. Avoid repetitive paragraph structures and do not interpret the data here.

DiscussionT h e f u n c t i o n o f t h e d i s c u s s i o n i s t o interpretresults in light of what was already known about the subject of the investigation, and to explain new understanding of the problem after taking results into consideration. The discuss ion wi l l a lways connect to the introduction by way of the question(s) or hypotheses posed and the literature cited and incorporated the major ndings of the study. Discussion should be organized and addresses other studies in relation to the ndings presented in the results. Moreover, it should also provide interpretation of present study understanding in the larger context of the problem.

The literature to your own area of research and investigation. How does your own works draws upon, departs from or synthesis what has been said in the literature?

Keep the primary focus on the literature pertinent to your research problem

The various arguments, theories, methodologies and ndings expressed in the literature. What do the authors agree on? Who applies similar approaches to analysis of the research problems?

The various agreements, theme, methodologies, approaches and controversies expressed in the literature; what are the major areas disagreement, controversies and debates?

Which arguments are more persuasive and why? Which approaches, nding, methodologies seem most reliable, valid and appropriate and why? Pay attention to the verbs you use to describe what an author’s says/does (e.g. asserts, demonstrate, etc.)

Cite

Compare

Contrast

Critiques the literature

Connect


This section also include the i. Strengths of the study, ii. Limitation of the Study, iii. Conclusion and iv. Recommendations.

AcknowledgmentThe purpose of acknowledgment is to pay gratitude to all those who have supported in carrying out research. It is advisable to include people in the proper order according to the importance of their help they paid. Appreciation should be concise and expression should not be so emotional.

Submission checklistYou can use this list to carry out a nal check of your submission before you send it to the journal for review. Please check the relevant section in this Guide for Authors for more details.Ensure that the following items are present:One author has been designated as the corresponding author with contact details:

Journal policies detailed in this guide have been reviewed Referee suggestions and contact details provided, based on journal requirement

E-mail address Full postal address

All necessary les have been uploaded:Manuscript: Include keywords All gures (include relevant captions) All tables (including titles, description,footnotes) Ensure all gure and table citations in the text match the les provided Indicate clearly if color should be used for anygures in print Graphical Abstracts / Highlights les (where applicable) Supplemental les (where applicable)

Further considerations Manuscript has been 'spell checked' and 'grammar checked' All references mentioned in the Reference List are cited in the text. Permission has been obtained for use of copyrighted material from other sources (including theInternet) A competing interest's statement is provided, even if the authors have no competing interests to declare

Declaration of InterestAll authors must disclose any nancial and personal relationships with other people or organizations that could inappropriately inuence (bias) their work. Examples of potent ia l conic ts of in teres t inc lude employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/ registrations, and grants or other funding. Authors must disclose any interests in two places:1. A summary declaration of interest statement in the title page le or the manuscript le. If there are no interests to declare then please state this: 'Declarations of interest: none'. This summary statement will be ultimately published if the article is accepted.2. Detailed disclosures as part of a separate Declaration of Interest form, which forms part of the journal's ofcial records. It is important for potential interests to be declared in both places a n d t h a t t h e i n f o r m a t i o n m a t c h e s .

Submission declaration and vericationSubmission of an article implies that the work described has not been published previously (except in the form of an abstract or as part of a published lecture or academic thesis or as an electronic preprint, and that it is not under consideration for publication elsewhere, that its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form.

AuthorshipAll authors should have made substantial contr ibut ions to a l l o f the fo l lowing: 1. The conception and design of the study, or a c q u i s i t i o n o f d a t a , o r a n a l y s i s a n d interpretation of data.


2. Drafting the article or revising it critically for i m p o r t a n t i n t e l l e c t u a l c o n t e n t .3. Final approval of the version to be submitted.

Changes To AuthorshipAuthors are expected to consider carefully the list and order of authors before submitting their manuscript and provide the denitive list of authors at the time of the original submission. Any addition, deletion or rearrangement of author names in the authorship list should be made only before the manuscript has been accepted and only if approved by the journal Editor. To request such a change, the Editor must receive the following from the corresponding author: (a) the reason for the change in author list and (b) Written conrmation (e-mail, letter) from all authors that they agree with the addition, removal or rearrangement. In the case of addition or removal of authors, this includes conrmation from the author being added or removed.

CopyrightUpon acceptance of an article, authors will be asked to complete a 'Journal Publishing Agreement' i.e., Authors transfer copyright to the publisher as part of a journal publishing agreement, but have the right to: Share their article for Personal Use, Internal Institutional Use and Scholarly Sharing purposes, with the version of Journal only Retain patent, trademark and other intellectual property rights (including research data). Proper attribution and credit for the published workPermission of the Publisher is required for resale or distribution outside the institution and for all other derivative works, including compilations and translations. If excerpts from other copyrighted works are included, the author(s) must obtain written permission from the copyright owners and credit the source in the article.

Role of the funding sourceYou are requested to identify who provided nancial support for the conduct of the research

and/or preparation of the article and to briey describe the role of the sponsor(s), if any, in study design; in the col lect ion, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. If the funding source(s) had no such involvement then this should be stated.

Informed consent and patient detailsStudies on patients or volunteers require ethics committee approval and informed consent, which should be documented in the paper. Appropriate consents, permissions and releases must be obtained where an author wishes to include case details or other personal information or images of patients and any other individuals.

SubmissionSubmission of the articles is through online email to the editor the email is …………… All the correspondence regarding the article publication will be through the above mentioned email. Formatting.Standard manuscript form, double-spaced, is requested. Each page should be numbered consecutively, beginning with the title page. Include each author's name, highest academic degree earned, and institutional afliation on the title page as well as the mailing address, telephone number, and e-mail address of the corresponding author.

PreparationAs part of the Your Paper Your Way service, you may choose to submit your manuscript as a single le to be used in the refereeing process. This can be a PDF le or a Word document, in any format or lay- out that can be used by referees to evaluate your manuscript. It should contain high enough quality gures for refereeing. If you prefer to do so, you may still provide all or some of the source les at the initial submission. Please note that individual gure les larger than 10 MB must be uploaded separately.

ReferencesThis journal follows the referencing style of APA Sty le and the 6 th edi t ion . Format t ing requirement The journal follows a certain


separately from the article, so it must be able to stand alone. For this reason, References should be avoided, but if essential, then cite the author(s) and year(s). Also, non-standard or uncommon abbreviations should be avoided, but if essential they must be dened at their rst mention in the abstract itself.Abstracts should contain 150 to 200 words.

KeywordsImmediately after the abstract, provide a maximum of 6 keywords, using American spelling and avoiding general and plural terms and multiple concepts (avoid, for example, 'and', 'of'). Be sparing with abbreviations: only abbreviations rmly established in the eld may be eligible. These keywords will be used for indexing purposes.

AbbreviationsIn the text, avoid the use of abbreviations; spell terms out in full.

AcknowledgementsCollate acknowledgements in a separate section at the end of the article before the references and do not, therefore, include them on the title page, as a footnote to the title or otherwise. List here those individuals who provided help during the research (e.g., providing language help, writing assistance or proof reading the article, etc.).

Formatting of funding source

List funding sources in this standard way to facilitate compliance to funder's requirmentFunding: This work was supported by the National Institutes of Health [grant numbers xxxx, yyyy] ; the Bi l l & Melinda Gates Foundation, Seattle, WA [grant number zzzz]; and the United States Institutes of Peace [grant number aaaa].If no funding has been provided for the research, please include the following sentence: This research did not receive any specic grant from funding agencies in the public, commercial, or not-for-prot sectors. Units Follow internationally accepted rules and conventions: use the international system of units (SI). If other units are mentioned, please give their

equivalent in SI. FootnotesFootnotes should be used sparingly. Number them consecutively throughout the article. Many word processors build footnotes into the text, and this feature may be used. Should this not be the case, indicate the position of footnotes in the text and present the footnotes themselves separately at the end of the article.

Artwork Electronic artwork General points Make sure you use uniform lettering and sizing of your original artwork. Preferred fonts: Times New Roman. Number the illustrations according to their sequence in the text. Use a logical naming convention for your art work les.Please note that individual gure les larger than 10 MB must be provided in separate source les. Formats Regardless of the application used, when your electronic artwork is nalized, please 'save as' or convert the images to JPG format.

Figure captionsEnsure that each illustration has a caption. A caption should comprise a brief title (not on the gure itself) and a description of the illustration. Keep text in the illustrations themselves to a minimum but explain al l symbols and abbreviations used.

TablesPlease submit tables as editable text and not as images. Tables can be placed either next to the relevant text in the article, or on separate page(s) at the end. Number tables consecutively in accordance with their appearance in the text and place any table notes below the table body. Be sparing in the use of tables and ensure that the data presented in them do not duplicate results described elsewhere in the article. Please avoid using vertical rules and shading in table cells.

ReferencesCitation in text. Please ensure that every reference cited in the text is also present in the reference list (and vice versa). Any references cited in the abstract must be given in full.


U n p u b l i s h e d r e s u l t s a n d p e r s o n a l communications are not recommended in the reference list, but may be mentioned in the text. If these references are included in the reference list they should follow the standard reference style of the journal and should include a substitution of the publication date with either 'Unpublished results' or'Personal communication'. Citation of a reference as 'in press' implies that the item has been accepted for publication.

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AJAHS VOL. 03 ISSUE 03 JUL-SEP 2018

Pakistan Journal of Nursing and MidwiferyLahore School of NursingThe University of Lahore,Lahore Pakistan

Editorial Boardpatron in Chief.Mr. M. A. Raoof

Patron

Editor in ChiefProf. Dr. Syed Amir Gilani

EditorMr. Muhammad Afzal Ms. Sana SaherMr. Muhammad Hussain

Prof. Awais Raoof

Prof. Dr. Syed Amir Gilani

Occupational Health Hazards and Physical Health Among Nurses

Zuha Ahmad, Sana Sehar & Syeda Tasneem Kausar

Awareness of Biomedical Waste Management Among Nurses

Afsar Ali, Ayesha Rasheed, Muhammad Hussain & Rubina Jabeen

Factors Affecting Academic Performance of Undergraduate Nursing Students

Sania Jamshed, Muhammad Hussain & Tazeen Saeed Ali

Impact Of Extrinsic Motivation On Job Satisfaction Among Nurses

Kousar Perveen, Iram Majeed & Muhammad Jafar

Impact of Workplace Empowerment on Organizational Commitment among Nurses

Iram Majeed, Sarwat Noor& Sarfaraz Masih

Nurses' Knowledge Regarding Pressure Ulcer Prevention

Muhammad Azhar, Misbah Zafar& Abdul Haque Khoso

ISSN 2663-1245 (Print) VOL. 01 ISSUE 01 JAN-MAR 2017

2663-1245

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AJAHS VOL. 03 ISSUE 03 JUL-SEP 2018

Pakistan Journal of Nursing and MidwiferyLahore School of NursingThe University of Lahore,Lahore Pakistan

CoordinatorMs. Kousar PerveenMs. Iram Majeed

Member

NationalDr. Tazeen Sayeed AliDr. Dildar SwatiMr. Afsar AliMr. Zafar Iqbal

InternationalDr. Fouzia AliAssociate ProfessorUniversity of Alberta

Dr. Parveen Azam AliUniversity of Sheffeild

Dr. Salma RehmanUniversity of Hull

Publication Ofce Mr. Muhammad Afzal Associate Professor / PrincipalEditor Pakistan Journal of Nursing and MidwiferyLahore School Of NursingThe University Of LahoreLahore Pakistan

Work place stressors and the coping behaviors among nurses in Lahore, Pakistan

Kinza Mahboob, Muhammad Afzal & Sana Sehar

Effects of Workplace Bullyingon Turn over Intention among Nurses

Muhammad Hussain, Muhammad Sabir & Muhammad Yousif

ISSN 2663-1245 (Print) VOL. 01 ISSUE 01 JAN-MAR 2017

Letter of Authorship 69

01VOL 01 ISSUE 01 JAN-MAR 2017

Guest Editorial

It is my honor to introduce the Pakistan Journal of Nursing and Midwifery (PJNM) being launched by the Lahore School of Nursing, one of the most respected platform of the gifted researchers and academicians of The University of Lahore.The establishment of Lahore School of Nursing as The University of Lahore was indeed an arduous undertaking but was worth-the –while. Several constrains became apparent as we interacted with nursing professionals across the world, but at the end of the effort was productive and The University of Lahore has one of the best department in this eld.I characterized the Pakistan Journal of Nursing and Midwifery as unique publication on the eld of nursing that would advocate and promote the professional attitude in the nursing eld. As a matter of fact, the nursing profession work with other branches of the health sciences, as Pakistan context, there is no organization to work as a mouthpiece and representatives of the nursing profession. Nursing profession is in inventive stage. Nursing education will be shifted from nursing boards to medical universities. Baccalaureate level nursing education for entrance to practice ,an increase number of masters in advance nursing, Production of doctorate Nursing scholars, broadening the scope of practice, title of clinical nurse specialists, establishing nursing research institutions, foundation of professional nursing associations and professional societies of nursing scholars are the forecasting directions in the country. It is quite clear that the path to professional certication all over the world is much shorter than it is in Pakistan, because of government delinquent urgency. The “degree scramble” we have witnessed in Pakistan has not hit countries outside from its outer borders. On a positive aspect, the matter of recognition at the government and social level of nursing health professional versus medicine & dentistry seems to be a universal issue. I hope this journal work as a platform for the “birds of a feather ocks together”. It will be a torch bearer in the eld of Nursing and an iconoclast for the traditional wrong customs, beliefs, norms that are ill-practiced in this eld. Stay tuned!

Prof. Awais RaoofChairman (BOG)

The University of Lahore


Editorial

Nursing profession set a number of skills and acting in a particular way. Nursing should be considered a profession because it requires an extended education and has a practical implication of the knowledge; to act professionally, means to administer care in a conscientious and knowledgeable way without impeding harm on others. From the past to the recent time nurses have made a great strive for their recognition in the society as productive and knowledgeable professionals. The future of nursing is in the hands of nurses themselves. By encouraging further education and continuing education, the profession of nursing will continue to evolve and gain power. By learning to speak out and publicize the plight of nursing today, nurses can either help the public understand why the healthcare system needs to change, and how changes can be made, or if done carelessly, may contribute to a negative image in the public eye. I think nurses hold the power to change the healthcare system in our country, but we must rst become organized and work together. Institutions nish their education without being aware of the fact that they are allied health professionals. Unlike other kind of health professionals where the name of institutions contain the words such as nursing and medicine, only 25 of the 113 institutions in Pakistan offering such courses, have the word allied health in their names, In some cases, the omission is justied because the institution includes other kinds of programs such as nursing and pharmacy as well.In other instances, however, there is greater preference for the title to be health sciences or health professions. The lack of specic identier in the name of the academic institution is not a strong inducement for students and faculty to consider themselves as a part of allied health, institution. The Faculty of Lahore School of Nursing at the University of Lahore being the largest faculty of this subject in the country, with 11 departments offering undergraduate to Doctoral degree programs has taken the lead in allied health education and research in the region. The Asian Journal OF Lahore School of Nursing is a step forward to make this faculty as center of excellence in Lahore School of Nursing. I can foresee that many journals will emerge from this journal in near future and will create a wave of motivation in the allied health professionals to start publishing their clinical as well as research work. Recognizing the consequences that stem from the aforementioned deciencies, the Faculty of Lahore School of Nursing at the University of Lahore, which was established in Feb, 2012 has formed a Branding Task Force. Members of the Task force met in Lahore on July 18, 2016 with representatives of company that specializes in branding. The purpose of the branding is to identify and disseminates information about the “One Thing” that distinguishes allied health from everything else in the health eld. Achieving that aim will help the audience remember the name of allied health, know what it represents, and perceive the value that allied health offers.

Prof. Dr. Syed Amir GilaniEditor in Chief

Pakistan Journal of Nursing and MidwiferyLahore School Of NursingThe University Of Lahore

Lahore Pakistan

INTRODUCTION


Nurses are the largest group of health care workers, who provide and promote health and reduce injury and illness. In order to provide this

care, nurses need to be healthy. But in facilitating and providing care to others, nurses themselves encountered various health hazards in their

Orignal Pakistan Journal of Nursing and Midwifery

ABSTRACT

Correspondence Address IntroductionNurses are health care providers who provide care to patients, whereas in providing care, nurses themselves encountered various occupational health hazards (OHH) which are potential risks to health and safety that could compromises their physical health. These hazards has direct affect on the physical health of nurses and indirect affect on their efciency and ability of work.

MethodsAn analytical cross-sectional design was used to collect data from sample of 195 nurses of tertiary care public hospital using convenient sampling technique. WRRS ( work related symptom scale ) was used to identify OHH nurses faces and PHQ( physical health questionnaire) was used to identify the physical health in nurses related to these hazards. Data analysis by entering the data on SPSS software.

ResultsThe highly present occupational health hazards were back pain(59.9%), sleep disturbance (49.0%) and irritation with everything because of work (39.5%). A signicant relationship of p<0.05 was found between OHH and physical health in nurses. Relationship of components of OHH was also seen with physical health of nurses in this study. There was strong signicant relationship between physical hazards and physical health in nurses, signication relationship between social hazards and physical health and no signicant relationship between psychological hazards and physical health in nurses.

ConclusionsThere was signicant association between OHH and physical health of nurses. Based on results, it is concluded that nurses of tertiary care public hospital faced different OHH which compromise their physical health. More common hazards were sleep disturbance, back pain, body pain, irritation with everything, bitterness in self and family and social relation difculty.

Keywords Occupational health hazards, physical health in nurses.

Occupational Health Hazards and Physical Health Among Nurses

Zuha Ahmad, Student of BSN, Lahore School of Nursing, The University of Lahore, Lahore, Pakistan

Syeda Tasneem Kausar, Assistant Professor, Superior University, Lahore, Pakistan

Sana Sehar, Assistant Professor, Lahore School of Nursing, The University of Lahore, Lahore, Pakistan

Zuha Ahmad,Student of BSN,Lahore School of Nursing,The University of Lahore, Lahore, [email protected]


occupation (Ramsay, 2005). A signicant role is played by work environment in the personal and professional life of employee and their physical health. More attention should be paid in identifying and dealing with working place health hazard (Vaz, 2010). Health hazards has impact on physical and overall health of employees because employees suffer more from chronic stress and dissatisfaction when they have a negative perception of their environment (Noblet, 2006). Occupational health hazards are potential risks to health and safety that are performed outside the home by workers and reduce the level of satisfaction of nurses regarding their physical health (Sadaf, 2011). Occupational health hazards could be physical, social or psychological which affect physical health of employees. Common hazards nurses faces include needle stick injury, body pain, back pain, sleep disturbance, rotating shifts injuries, irritation with everything, bitterness in self, family and social relation disturbance. These hazards effect their physical health (Sadaf, 2011). These hazards has direct affect on the physical health of nurses and indirect affect on their efciency and ability of work as, physical health is the optimum functioning without problems like headache, sleep disturbance etc. A cross sectional study conducted in Philippines revealed that nurses in Philippines experience injuries and illness at the workplace because of the work. 32% reported that they got injured 1 to 2 times in the past year. 6% reported having been injured at least 3 times (Honda, 2011). Because of a work-related injury or illness, number of respondents who noted they missed more than 2 days of work during the past year were 31%. (78%) experienced back pain because of health hazards they encountered at workplace (De Castro, 2009). According to study conducted in India, nurses faces different health issues including headache, gastric disorders and depression and 31% of respondents missed more than 2 days of work during the past year because of health hazards (Anbazhagan, 2016). Study conducted in

Pakistan showed prevalence of musculoskeletal disorder in 12 month period was 31.6%. Low back site was the most common (32%) then the shoulder site (20%), upper back, and knees (10%) (Rathore, 2017).

Occupational health hazards and physical health among nurses

A cross sectional descriptive study was conducted by Eljedi (2015) in Palestine. The results of study showed that at least one of the occupational hazards was faced by 44.3% of nurses in beginning of their career. Physiological hazards has highest exposure about 56.5% and 44.0% are accidental hazards and back injuries rate (37.7 %). Of the physical hazards, back pain is common in nurses. According to a cross sectional survey performed on nurses in Taiwan. Of the physical hazards, nurses face in their workplace, 567 (72.0%) had lower back pain. Nurses with LBP had longer average hours at work as compared with non-LBP group (p<0.05) (Rathore, 2017). A study shows that nurses with work experience are exposed to workplace hazards and there is 2.11 times higher risk of lower back pain in nurses with 2-5 years' service than those with less than 2 years in service which reduces nurses efciency to work and quality of care (Shieh,2016). Sleep disturbance is also commonly faced by nurses. Sleep disorders and headaches are the physical health hazards and they both are more prevalent among nurses in comparison to general population. The primary headaches include tension-type headache (TTH), migraine and chronic daily headache (CDH). Poor sleep prevalence, was in 56.7 % nurses. Of these, 34.13 % experience poor sleep along with headaches. Poor sleep was signicantly higher in those with CDH (82.1 %), TTH (59.0 %) and migraine (78.9 %), than in those without headaches (47.3 %) (all P� <� 0.05) (Wang et al., 2015). Majority of the

shifts workers specially those who work in hospital are continuously busy in operating place even in weekends and holidays, when there is more social and family interactions. Consequently, among shift workers, spending very less time with family is the most common and negatively rated complaint making them

RESULTS


irritated with every thing and stressed because of work (Hughes, 2008). Psychological hazards has signicant impact on physical health of nurses. These hazards are experiencing sadness, emptiness over time, irritation with everything, felling bitterness in self which could result in sleep disturbance, headache or gastric issues (Buley, 2016).

Aims of the Study The aim of this study was to identify the relationship between occupational health hazards and physical health among nurses.


The research was conducted in tertiary care public hospital in Lahore. Quantitative analytical cross sectional study design was used. The target populations were nurses. Convenient sampling technique was used.In this study, two questionnaire were used. Work Related Symptom Scale was used to measure OHH. Developed by Ferreira and M e n d e s i n 2 0 0 7 a n d P h y s i c a l H e a l t h Questionnaire scale was used to measure physical health in nurses, developed by Spence et al., in 1987.A formal written letter of permission to conduct the research was taken from institution. Data was gathered by using questionnaires of WRSS and PHQ, led by nurses.Participants were informed about the purpose of study. Consent form was signed before lling the questionnaire. Respondents were assured that their information would be kept condential Participant were not forced to participate by giving them any rewards Fair and equal chances were provided to participants to participate.

MARTIAL & METHODS

unmarried. 14.9% were divorced and 5.1% were widow. 69.1% nurses were performing regular morning duties 10.3%, regular nights duties and 24.6%, two shift rotation duties. 74.9% had work experience between 1-10 years and 25.1% had work experience between 10-20 years. All respondents were working in single facility with 100%, 49.7% nurses were working in medical ward, 20% in emergency, 20% in CCU ward and 10.3% in surgical ward. 80% of respondents had duty hours of 6 hours and 20% of respondents had duty hours of 12 hours.

Data was collected from nurses, Table 1 show that 64.6% nurses belong to 20-30 age group. 25.1%, belong to 30-40 age and 10.3% belong to age 40-50. 55.4% of respondents belong to Lahore and 44.6% belong to other cities. 49.7% of respondents were married, 30.3% were

According to table 2, the highly present occupational health hazards were back pain (59.9%), sleep disturbance (49.0%) and irritation with everything because of work (39.5%) Moderately present hazards were experiencing bitterness in self (39.0%) and difculty in social life (37.9%). Totally absent hazards were circulatory (80.0%) disturbance and respiratory disturbance (89.7%). Table 3 showed most common physical health issues nurses experience were Headache because of work pressure (63.1%) and sleep disturbance (60.5%).According to Pearson test as shown in table 4, there is strong signicant and small negative correlation between physical hazards and physical health. p= .009 and r= -.187. Between psychological hazards and physical hazards, there is no signicant relationship with p= .387 and r= -.062. Between social hazards and physical health, there is small negative correlation between social hazards and physical health with p= .026 and r= -.160.

Table 1. Demographic Characteristics

Table 4. Relationship of Physical Hazards

and Physical Health

Table 5.

R Square F Sig. F Beta



Health hazards Highly present

Moderately present

Totally absent

Symptoms of sleep disturbance due work load.

49.0%

Experience back pain after the work.

59.9%

Irritation with everything because of work problems.

39.5%

experience bitterness in yourself

39.0%

Social life difculties 37.9circulatory disturbance 80.0%Respiratory disturbance

89.7%

Table 2. Frequencies of Health Hazards Among Nurses

Most common physical health issues %

Experiencing headache because of work pressure

63.1%

Difculty in sleep 60.5%

Table 3. Frequencies of Physical Health

Issues among Nurses

area. E.R ward 20.0CCU 20.0Sur.W 10.3

Working hours. 6 hours 80.012 hours 20.0

area. E.R ward 20.0CCU 20.0Sur.W 10.3

Working hours. 6 hours 80.012 hours 20.0

Regression Test among Physical

Hazards and Physical Health

Change Change Change.019 3.755 .044 -.138

Result of simple regression in Table no 5 revealed signicance value of (p=0.044), showing signicance relationship between OHH and physical health in nurses. The beta value is -.138, showing negative association between OHH and physical health in nurses. F statistics shows value of 3.755 and R square change is .019.

DISCUSSION

In this study, there was signicant relationship between occupational health hazards and physical health in nurse with. According to a research conducted in Palestine, signicant relationship was present between OHH and physical health in nurses. These hazards mostly cause sleep disturbance, headache and other health issues in nurses (Ghosh,2013). The signicant relationship between occupational health hazards and physical health could be due to unequal distribution of staff, excessive workload and workplace stress regarding the components of OHH, there is strong signicant relationship between physical hazards and physical health of nurses because the more prone to physical hazards while performing their duty. According to ndings of a research, nurses faces wide range of hazards at workplace and physical hazards has highest exposure about 56.5%. Among them body pain and back pain are most



common and respiratory, circulatory and auditory disturbance are least common (Eljedi, 2015). Between social hazards and physical hazards, there is signicant relationship. The relationship is signicant because it disturb both professional and personal life activities of nurses the most. Finding of Sharma, (2014) showed that nurses are often busy in hospitals and could not take part in many social activities making them irritated and frustrated because of work. But there is no signicant relationship between psychological hazards and physical hazards in this study. This could be because nurses in this hospital are not affected by psychological hazards either because they became immune to these hazards and they, now are not affected by them or either they have developed some strategies to cope with them. According to a study, when workload increases, level of stress, bitterness and irritation in nurses also increases and these nurses faces more psychological hazards. Educating new nurses how to handle stress, teaching different strategies to deal with them and giving them training to tackle are some ndings that help nurses to deal with psychological hazards (Sharma, 2014).This study was conducted in a public hospital of Lahore which limits generalizability of this study in private hospital. Convenient sampling techniques was used because of limited resources, which was also a limitation of study Respondents were asked to answers the questionnaires on their previous experience which is recall bias and therefore considered as another limitation of study.Based on results of this study, it can be concluded that nurses of Mayo Hospital faced different OHH which compromise their physical health. There was negative signicant association between OHH and physical health of nurses. More common hazards were sleep disturbance, back pain, body pain, irritation with everything, bitterness in self and family and social relation difculty, which could results in sleep disturbance, experiencing more headache, gastric and other health issues.

AcknowledgementSpecial thanks to the head nurses and nursing superintendent and to the participants nurses who willingly participated in the study.Mr. Fiaz and Mrs. Fiaz for their continuous prayers and cheering. I also present my gratitude to my friends who helped me alot during this research.

REFERENCES

Anbazhagan, S., Ramesh, N., Nisha, C., &

Buley, R. B. K. (Ed.). (2010). Nurses on the run:

De Castro, A. B., Cabrera, S. L., Gee, G. C.,

Joseph, B. (2016). Shift work disorder and related health problems among nurses working in a tertiary care hospital, Bangalore, South India. Indian journal of o c c u p a t i o n a l a n d e n v i r o n m e n t a l medicine, 20(1), 35.

Why they come, why they stay. Dog Ea Publishing

Eljedi, A. (2015). Prevalence and response to

Fujishiro, K., & Tagalog, E. A. (2009). Occupational health and safety issues among nurses in the Philippines. Aaohn Journal, 57(4), 149-157.

Occupational Hazards among Nursing Students in Gaza Strip, Palestine: The role of Personal Protective Equipment and Safety Regulations. Public Health Research, 5(1), 32-38.

Ghosh,T .(2013). Occupational health and hazards among health care workers.

Honda, M., Honda, M., Chompikul, J . , Chompikul, J., Rattanapan, C., Ratanapan, C., .& Klungboonkrong, S. (2011). Sharps injuries among nurses in a Thai regional hospital: prevalence and risk factors.

International Journal of Occupational Safety and Health, 3(1), 1-4.

Sadaf, J., & Yaqoob, T. (2011). Gender based

occupational health hazards among



Vaz, K., McGrowder, D., Crawford, T.,

Alexander-Lindo, R., & Irving, R. (2010). Prevalence of injuries and reporting of accidents among health care workers at the University Hospital of the West Indies. International journal of occupational medicine and environmental health, 23(2), 133-143.

Wang, Y., Xie, J., Yang, F., Wu, S., Wang, H.,

Zhang, X., ... & Yu, S. (2015). Comorbidity of poor sleep and primary headaches among nursing staff in north China . The journal of headache and pain, 16(1), 88.

Sadaf, J., & Yaqoob, T. (2011). Gender based

Shieh, S. H., Sung, F. C., Su, C. H., Tsai, Y., &

occupational health hazards among paramedical staff in public hospitals of J h e l u m . I n t e r n a t i o n a l J o u r n a l o f Humanities and Social Science, 1(3), 175-180.

Sharma, P., Davey, A., Davey, S., Shukla, A.,

Shrivastava, K., & Bansal, R. (2014). Occupational stress among staff nurses: Controlling the risk to health. Indian journal of occupational and environmental medicine, 18(2), 52.

Hsieh, V. C. R. (2016). Increased low back pain risk in nurses with high workload for patient care: A questionnaire survey. Taiwanese Journal of Obstetrics and Gynecology, 55(4), 525-529.

Rathore, F. A., & Rayan Attique, Y. A. (2017).

P r e v a l e n c e a n d P e r c e p t i o n s o f Musculoskeletal Disorders Among Hospital Nurses in Pakistan: A Cross-sectional Survey. Cureus, 9(1).

Ramsay, J. D. (2005, January). A new look at

nursing safety: The development and use of JHA in the Emergency Department. In ASSE Professional Development Conference E x p o s i t i o n . A m e r i c a n Society of Safety Engineers.

paramedical staff in public hospitals of J h e l u m . I n t e r n a t i o n a l J o u r n a l o f Humanities and Social Science, 1(3), 175-180.


During Patients' stay at hospital many products are used and at the end there are some waste produced. They are called as Hospital waste or Biomedical waste (Basu, Das, & Pal, 2012). Hospital waste or biomedical waste is dened as "any solid, uid, or liquid waste including its containers and any intermediate product which is generated during the diagnosis, treatment, or immunization of human beings (Enein, Abou, & Zaghloul, 2011). The absence of proper waste management, lack of awareness about the health hazards from BM waste, insufcient nancial and human resources, and poor control of waste

disposal are the most critical problems connected with health care waste" Sharma, Sharma, Sharma, & Singh, 2013). Proper treatment of Bio-medical waste is a greater concern for both the Health care professionals a n d t h e p a t i e n t s a n d c o m m u n i t y (Yadavannavar, Berad, & Jagirdar, 2010). Health Care Waste is the second dangerous waste in the World that needs to be properly disposed by t r a i n e d h e a l t h c a r e s t a f f " ( K u m a r , Samrongthong, & Shaikh, 2013). A sufcient knowledge and quality practice among the health care workers is the need for managing the


Afsar Ali, Assistant Professor, Sayeeda Waheed Nursing College, Fatima Memorial Hospital, Lahore, Pakistan.

Ayesha Rasheed, Post RN, BSN Hameed Latif Hospital Lahore. Lahore, Pakistan

Muhammad Hussain, Assistant Professor, Lahore School of Nursing, The University of Lahore, Pakistan.

Rubina Jabeen, Lahore School of Nursing Superior University, Lahore, Pakistan

ABSTRACT


Correspondence Address

Afsar Ali, Assistant Professor, Sayeeda Waheed Nursing College, Fatima Memorial Hospital, Lahore, [email protected]

Background Health Care Waste is the second dangerous waste in the

World that needs to be properly disposed by trained health care staff". Sufcient knowledge and quality practice among the health care workers is the need for managing the hospital waste effectively. A study was conducted to assess the awareness level of nurses about the biomedical (BM) waste management at Lahore general Hospital Lahore.

MethodsA cross sectional study design was used for this study. A sample of 260 nurses was selected from different units of hospital through convenient sampling. Data was collected by a self-administered questionnaire. The data was analysed by SPSS version 21 and was represented in the form of charts, tables frequencies and percentages

ResultsThe ndings of this study showed that 30% of the study participants had poor awareness about the biomedical waste management, 54% had moderate awareness while only 16% had good knowledge about biomedical waste management.

ConclusionsIt was concluded that nurses have inadequate awareness about the biomedical waste management and its effective management.

Keywords Nurses, Awareness, Biomedical Waste.

INTRODUCTION



hospital waste effectively. Hospitals where the workers do not have enough knowledge and proper practice may face a very high number of hospital acquired infections . Thus it becomes very necessary to assess the knowledge and practices of health care workers especially nurses about the waste disposal in the hospitals. It is studied by literature that the biomedical waste management is divided into four main categories. Firstly, segregation of waste in different elements such as provision of safe containers where the waste can be stored; secondly, Transportation of the waste to the treatment sites; thirdly appropriate treatment of waste, and fourthly proper disposal. It was suggested by the researcher that the above mentioned components are the main steps to manage the wastes at any organization in a scientic manner (Mathur et al., 2011). It is further suggested that more specically if someone wants to determine the categories of biomedical waste, it can be done with the help of plastic bags with different color codes and containers (Sharma et al., 2013) . The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensication (Ananth, Prashanthini, & Visvanathan, 2010) . Biomedical waste management was assessed among the participants which include categories of biomedical waste, related health hazards, diseases transmitted by mishandling of biomedical waste, and knowledge about the different color coding. The results suggest that less than fty percent of the study participants had received proper training about biomedical waste management. Overall very low number of

participants were having knowledge about the biomedical waste management . An important research study conducted who studied awareness of biomedical waste management among health care personnel in India. It was found that 36% of nurses were having very poor knowledge about the legislation of biomedical waste management. A very high number of participants agreed that safe waste management is not the issue of their hospital (Sushma, 2010).A survey conducted by Kumar et al., (2013), who studied knowledge, attitude and practices of health staff regarding infectious waste handling. The results show that majority of the participants were males and few were females. The average age of the participants was about 3o years old. Furthermore the results showed that nurses were having better knowledge than other health care workers. Almost half of the nurses were aware about the management of waste according to WHO standards. Nurses were having poor knowledge about the collection procedure of biomedical waste different parts of the hospital (Kumar, et al ., 2013). A study conducted by Mathew et al., (2011), assessed the concept of biomedical waste management in a tertiary care teaching hospital in Ludhiana. They found that nurses were having better knowledge about different aspects of biomedical waste management. A very high number of nurses had knowledge about the categories of biomedical waste. Yet a good number of nurses were aware of the color codes of different waste. 94.7% of the nurse's participants had knowledge about the methods of waste segregation. Moreover a large number of nurses were aware that the waste should be stored for less than 48 hours (Mathew, et al., 2011). In the study all the participants had knowledge about the waste disposal methods. Overall it was found that nurses were having equal or better knowledge than doctors. On the other hand the nurses were having comparatively low knowledge about theoretical aspects of biomedical waste such as existence of biomedical



waste rules, identication of bio-hazards symbol and the disease spread by improper handling of biomedical waste as compare to doctors (Mathur et al., 2011). A survey was conducted about Knowledge, attitude and practice of bio-medical waste management among personnel of a tertiary health care institute in India. The results of this study revealed that nurses are having poor knowledge regarding bio-medical waste management. Very small number of the study participants were aware of the color coding regarding biomedical waste. Furthermore very few nurses were aware about the reality that infectious waste is less than 25% of the total waste of the hospital waste (Ismail, et al., 2013). About the segregation of waste the nurses' knowledge was very good and they knew that biomedical waste has to be segregated at the point of its generation. All the study participants were having adequate knowledge about the disease transmission risk from biomedical hazards. They were aware that different infectious diseases can be generated from inappropriate handling of biomedical wastes (Sood & Sood, 2011)A study was conducted who studied the assessment of knowledge, regarding biomedical waste management among the healthcare workers in a tertiary care rural hospital. It was found that nurses had low knowledge about the rules of biomedical waste management as compare to doctors (Ndiaye, El Metghari, Soumah, & Sow, 2012). The knowledge of identication of symbols of bio-hazards was good among nurses as compare to other health care providers. The nurses' participants were having good awareness of the aspects of biomedical waste management in comparison to other health care staff (Radha, 2012).

Aims of The StudyThe purpose of this study was to assess the a w a r e n e s s a b o u t t h e h o s p i t a l w a s t e management among nurses at a tertiary care hospital Lahore.

This study was conducted at tertiary care public Hospital, which is a big tertiary care public Hospital. A descriptive cross sectional survey design was used. Cross sectional surveys are highly suitable for knowledge, attitude and practice studies. This cross sectional survey was based on a specically a designed questionnaire which identied the awareness of nurses about the biomedical waste.The targeted population of this specic study were the registered nurses who were working at tertiary care public hospital Lahore. For recruiting the study participants, a convenient non probability sampling methods was applied. Slovin’s formula is applied to calculate sample size. Hence, 260 nurses were recruited to participate in this study.Data was collected through a self-administered questionnaire. The questionnaire was composed of different closed ended questions about the knowledge of biomedical waste management among nurses. The questionnaire consisted closed ended structured statements. These questions were on dichotomous scale of ‘yes’ and ‘no’ about some biomedical waste aspects. he data was collected from May, 2015 to June, 2015.Their right to self-determination (Autonomy) was taken care during this study. A proper written informed consent was taken from the participating nurses to respect their right of autonomy. The informed consent was given in writing to the participants where they could give a willful permission to be part of the study. They were assured that their participation was fully voluntary and they could withdraw if they want. Furthermore, to protect the participants from any undesired effects, their condentiality was respected. Their names were kept optional and sensit ive information were not shared unnecessarily. To maintain condentiality codes or secret numbers were provided instead of

MARTIAL & METHODS



participants names

RESULTS

This section presents the outcomes of the study.Demographic ndings suggest that 45% of the participants were age 20-30 years, 40% were 31-40 years and 155 were above 40 years of age. A large number of nurses 98.84% were females while only 1.15% were male participants among the study participants. 80% 0f the study participants were having experience less than 5 years, 13.84% study participants were having experience 5-10 years and 6.15% were having more than 10 years of working experience as shown in the given table and graph.

%Variable n

Age of respondents

20-30 years

31–40 years40 years and above

117

10439

45

4015

Gender of Respondents

Females

Males

257

3

98.84

1.15

Experience of respondent

Less than 5 years

5-10 years

More than 10 years

208

36

16

80

13.84

6.15


The ndings of this study showed that 30% of the study participants had poor knowledge about the biomedical waste management, 54% had moderate knowledge while only 16% had good k n o w l e d g e a b o u t b i o m e d i c a l w a s t e management.

2Private agency mainly regulates waste generated at health care facilities.

159 61

S.No

StatementFrequency

(n)Percntage

(%)

1

Rule of Hospital Waste management was introduced by Federal Govt. of Pakistan in 2010.

187 72

Table 2. Awareness of Biomedical Waste management among Nurses

7

8

9

Method of treatment and disposal for Human anatomical Waste

Method of treatment and disposal for laboratory, cultures, specimens of microorganisms is Incineration

Amount of Risk

biomedical waste in hospitals is more than 50%

Biomedical waste should be segregated at the point of its generation.

10

Separation of Risk waste from non risk waste is termed as segregation

11

120

127

145

198

205

46

49

55.76

76

79

12

13

Sharps including the cut or broken syringes and needles shall be placed in to high density plastic containers

The sharp containers shall be closed when half full

216

161

83

62

3

4

5

6

Body uids contaminated with blood describes one type of Biomedical waste

Waste should be placed in containers lined with Yellow waste bags

Risk waste should be placed in containers lined with green bags

The color code for the BM waste to be autoclaved, disinfected is Yellow

213

208

122

211

82

80

47

81

14

15

All risk waste delivered to incinerator shall be burned within 24 hours

According to the Biomedical Waste Management Rules, waste should not be stored beyond 6 hours

185

192

71

74



DISCUSSION

The ndings of this study showed that 30% of the study participants had poor knowledge about the biomedical waste management, 54% had moderate knowledge while only 16% had good

k n o w l e d g e a b o u t b i o m e d i c a l w a s t e management. It simply reveals that the nurses are not well aware of the biomedical waste management. The ndings were consistent with different other studies, it was found that some studies have found similar kind of results that is poor knowledge of biomedical waste among nurses, while few studies have found better awareness among nurses. According to Sharma, et al., (2013), it was found that 36% of nurses

Table 3. Awareness of Biomedical Waste Management among Nurses

Status Number(n) Percent (%)

Poor Knowledge 78 30

Moderate Knowledge 140 54

Good Knowledge 42 16

Total 260 100

72% of the study participants were aware that rule of Hospital Waste management was introduced by Federal Government of Pakistan in 2010. 82% of the participants were aware that body uids contaminated with blood describes one type of biomedical waste. 80% of the nurses were aware that waste should be placed in containers lined with Yellow waste bags. Only 47% were aware that risk waste should be placed in containers lined with green bags. 46% of the participants were aware about the method of treatment and disposal for Human anatomical waste. 62% had awareness that the sharp containers shall be closed when half full. 71% were aware that all risk waste delivered to incinerator shall be burned within 24 hours. 74% were aware that according to the Biomedical Waste Management Rules, waste should not be stored beyond 6 hours.

were having very poor knowledge about the legislation of biomedical waste management. Another study revealed that overall very low numbers of part ic ipants were having knowledge about the biomedical waste management ( ). Kumar, Singh, & Umesh, 2015

According to another study conducted by (Kumar, et al., 2013), almost half of the nurses were aware about the management of waste according to WHO standards. Nurses were having poor knowledge about the collection procedure of biomedical waste different parts of the hospital (Kumar, et al., 2013).The studies that found somewhat different ndings are also discussed. According to Mathew et al., (2011), it was found that nurses were having better knowledge about different aspects of biomedical waste management. A very high number of nurses had knowledge about the categories of biomedical waste. Yet a good number of nurses were aware of the color codes of different waste. 94.7% of the nurses participants had knowledge about themethods of waste segregation. (Mathew, et al., 2011). According to Ismail, et al., (2013), all the nurses were having adequate knowledge about the disease transmission risk from biomedical hazards. They were aware that different infectious diseases can be generated from inappropriate handling of biomedical wastes . The study was conducted in a public setting with a small sample which might not be a true representative for all nurses therefore the ndings to much extent not be generalizable to all the nurses of Lahore.

ConclusionThe nurses' participants were studied for their awareness and knowledge about the biomedical waste at the health care setup. It was found from the study that few of the nurses were having good knowledge about the biomedical waste. a majority number were having moderate level of knowledge and a large number of nurses were having poor knowledge about the biomedical waste at the health care setups.



AcknowledgementSpecial thanks to the head nurses and nursing superintendent and to the participants nurses who willingly participated in the study.

Ananth, A. P., Prashanthini, V., & Visvanathan,

REFERENCES

Basu, M., Das, P., & Pal, R. (2012). Assessment of

Enein, E., Abou, N. Y., & Zaghloul, A. A. (2011).

C. (2010). Healthcare waste management in Asia. Waste Management, 30(1), 154-161.

future physicians on biomedical waste management in a tertiary care hospital of West Bengal. Journal of natural science, biology, and medicine, 3(1), 38.

Nurses' knowledge of prevention and management of pressure ulcer at a Health Insurance Hospital in Alexandria. International Journal of Nursing Practice, 17(3), 262-268.

Ismail, I. M., Kulkarni, A. G., Kamble, S. V., Borker, S. A., Rekha, R., & Amruth, M. (2013). Knowledge, attitude and practice about bio-medical waste management among personnel of a tertiary health care institute in Dakshina Kannada, Karnataka. Al Ameen J Med Sci, 6(4), 376-380.

Kumar, R., Samrongthong, R., & Shaikh, B. T.

(2013). Knowledge, attitude and practices of health staff regarding infectious waste handling of tertiary care health facilities at metropolitan city of Pakistan. Journal of Ayub Medical College Abbottabad, 25(1-2), 109-112.

Mathur, V., Dwivedi, S., Hassan, M., & Misra, R. (2011). Knowledge, attitude, and practices about biomedical waste management among healthcare personnel: A cross-

Narang, R. S., Manchanda, A., Singh, S., Verma,

N., & Padda, S. (2012). Awareness of biomedical waste management among dental professionals and auxiliary staff in Amritsar, India. Oral Health Dent Manag, 11(4), 162-168.

Ndiaye, M., El Metghari, L., Soumah, M., & Sow,

M. (2012). Biomedical waste management in ve hospitals in Dakar, Senegal. Bulletin de la Societe de pathologie exotique (1990), 105(4), 296-304.

Sachan, R., Patel, M., & Nischal, A. (2012). Assessment of the knowledge, attitude and practices regarding biomedical waste management amongst the medical and paramedical staff in tertiary health care centre. International Journal of Scientic and Research Publications, 2(7), 1-6.

Sharma, A., Sharma, V., Sharma, S., & Singh, P. (2013). Awareness of biomedical waste management among health care personnel in Jaipur, India. Oral Health Dent Manag, 12(1), 32-40.

Sood, A. G., & Sood, A. (2011). Dental

perspective on biomedical waste and mercury management: a knowledge, attitude, and practice survey. Indian Journal of Dental Research, 22(3), 371.

Sushma, S., & MK, B. (2010). Biomedical dental waste management and awareness of waste management policy among private dental practitoners in Mangalore city, India. Tanzania Dental Journal, 16(2), 39-43.

s e c t i o n a l s t u d y . I n d i a n j o u r n a l o f community medicine: ofcial publication of Indian Association of Preventive & Social Medicine, 36(2), 143.

Yadavannavar, M., Berad, A. S., & Jagirdar, P. (2010). Biomedical waste management: A study of knowledge, attitude, and practices in a tertiary health care institution in Bijapur. Indian journal of community medicine: ofcial publication of Indian Association of Preventive & Social Medicine, 35(1),170.

Kumar, M., Singh, R. K., & Umesh, V. R. (2015).

Awareness and practices about bio-medical waste among Health care workers in Tertiary care hospital of Haldwani, Nainital. Hindu, 159, 72-3.



ABSTRACT

Correspondence Address IntroductionEducation plays equivalent role among students’ performance. There are several factors that affect the academic performance. Academic performance has excessive impact on students' self-condence, ambition and fortitude in higher education. Poor academic performances may result in impermissible level of diminution, reduced graduates and greater cost of education. The aim of this study was to determine the factors affecting the academic performance of undergraduate nursing students.

MethodsQuantitative cross-sectional descriptive study design was used. A convenient sample of n=200 nursing students was selected from one nursing college Lahore.

ResultsFindings revealed that teacher discuss too many topics in short time of periods affect the most. Personal conditions having the subset feeling hungry in class is also affecting on academic performance. Home related factors e.g., living far from the school has the greater impact on learning.

Conclusions:Good academic performance is an essential element for achieving the future goals and competency. The ve factors that are contributing a major role in affecting the academic performance of nursing students are study habits, personal conditions, home related factors, school related factors and teacher related factors. Among all of the ve factors, teacher related are of the highest signicance.

Education is not merely a subject but it is a social tool that is used in every aspect of life. Education enlightens our minds and provides us strength to face any possible difculty in our lives. Majorly, education plays equivalent role among students as well as in teacher's performance. Students play a vital role in the any educational institute.

In fact, students are the essential possessions of the educational institute, Similarly, nursing students have a very signicant participation in improving the nursing standards through nursing education. Nursing is a very sacred profession which requires a lot of education. There are several factors that affect the academic

Factors Affecting Academic Performance of Undergraduate Nursing StudentsSania Jamshed, BSN student, Lahore School of Nursing, The University of Lahore, Pakistan.

Muhammad Hussain, Assistant Professor, Lahore School of Nursing, The University of Lahore, Pakistan.

Tazeen Saeed Ali, Associate Professor, Aga Khan University Karachi, Pakistan

Sania Jamshed, BSN student,Lahore School of Nursing,The University of Lahore, [email protected]

Keywords Academic performance, nursing, teacher-related, personal conditions, study habits,

home-related.

INTRODUCTION


performance. Academic performance has excessive impact on students' self-condence, ambition and fortitude in higher education, (Minnesota, 2007). Poor academic performances may result in impermissible level of diminution, reduced graduates and greater cost of education. Researchers have been interested from a long time in identifying and understanding the major aspects that contribute to academic performance in nursing students. The factors that came across through the studies are the personal conditions, health conditions, family related concerns, socio-economic factors, studying or learning habits and the teacher related aspects, (Brand, . & Klein, 2009). These are the factors that have an impact on academic performance due to the personal background of the students or their niche lifestyle. Moreover, out of all the various factors having an impact on the performance of a nursing student teachers' related aspect play a vital role. In nursing, student faces different circumstances. According to Snoober & Ramzan (2016) nursing students always perceive their teachers behaviour, viewpoint, character and condence. Students imitate and absorb by teachers' teaching. The effectiveness of the student's performance is determined by characteristics of their teacher.Moreover, out of all the various factors having an impact on the performance of a nursing student teachers' related aspect play a vital role. In nursing, student faces different circumstances. According to Snoober & Ramzan (2016) nursing students always perceive their teachers behaviour, viewpoint, character and condence.Students imitate and absorb by teachers' teaching. The effectiveness of the student's performance is determined by characteristics of their teacher. Study habits are also key factors that affect student's academic performance. According to study habits are the way of student's learning. It can be efcient or inefcient. Efcient study habits will give good academic performance and inefcient study habits wil l give poor

academic performance. Therefore, academic performance is closely linked with study habits.According to the study conducted in 2015, it was stated that the school related factors have great impact on student's results. About 20% of the students who attended classes were more likely to pass nursing schools.(Alos et al., 2015)According to Zysberg and Zysberg (2008), there has been 20%-35% of decline enrolment in higher education. This is related to the poor academic performance due to socio-economics status of the family. The poor socio-economic status has a very deep impact on student's mind that could be in form of stress or depression which disturbs student's performance in studies.Personal conditions have been noticed to bring change in the academic achievement. According to the study conducted in 2000, it has been stated that there are a set of variables involved in the personal condition of a student such as sleeping habits, eating habit, personal habit, age, gender, intellectual abilities, etc. that cause change in academic achievement.(Trockel, Barnes, & Egget, 2000).

Student's academic performance is the result of student's social, economic, psychological and environmental factors. For the last 20 years, the scope of research to nd the factors affecting the academic performance of the student is increasing because Pakistan is trying to acquire high quality of education. High quality education will produce highly and well educated students.In a study held by ', the causes were identied to measure the achievement gap of the students. This study developed the researcher's interest in systematically studying the factors that affect academic performance of students. The factors raised were the teacher-related, school-related, environment-related and home-related. These factors have a signicant effect on student's academic performance.According to and, teachers are the signicant factors in the learning of the student. An e f f e c t i v e l e a r n i n g o f t h e s t u d e n t i s obtained by understanding the students'

Factors Affecting Academic Performance


perception of teaching and teacher's behavior. Understanding the perception of the student will provide remedies for the better teaching-l e a r n i n g q u a l i t y . A c c o r d i n g t o t h e studyconducted by (Alos et al., 2015) it was stated that, being hungry in class has the second highest impact related to personal conditions that affect nursing student's academic performance. The personal conditions cause poor academic performances of the students which lead them towards stress and depression. Stress due to the personal conditions is again associated with poor academic performance .Robert Bjork identied the study habits in 2007. According to this review, research on the memory provides many ways to study more effectively. Testing the students is tone of the essential tip. It is necessary to study on the regular basis rather than studying at the last day of the exam. 2 out of 3 of the students study regularly and most of the students study at the last day of the exam. One of the most important components for improving the academic achievement in schools is the student's physical facilities. These schools related physical facilities are the classrooms, accommodation, school buildings, etc. Besides, the accessibility affects academic performance positively; likewise distant or poor school buildings affect academic achievement negatively. stated that there is theoretical relationship between classroom and student's learning that is a silent prospectus. They found that physical environment of the classroom acts as “Silent curriculum”. A study conduct by resulted in fact that the more the students are exposed to the quizzes, the more their academic performance is better.

teacherrelatedfactors

studyhabits

schoolrelatedfactoresfactors

effectingacademic

performances

persona habits

homerelatedfactors

Figure no.1.The conceptual framework given in gure no. 1 explains the different types of factors like, home-related, school-related, teacher-related, personal conditions and study habits affecting on the academic performances of the nursing students. These factors are closely related to change the academic performance of the nursing students. In order to improve academic performance, these factors need to be acknowledged and improved. Teacher-related factors are of great importance in nursing student's academic and professional life. Teachers are considered the core source of learning for students. Academic performance of student is greatly inuenced by teachers. The other factor is the school-related factors. Nursing students spend most of the time in their schools daily. Therefore, school imposes its own inuence on students. The building and environment of the school affect student's interest towards studies and academic performance. Home-related factors are involved in the student's academic achievement. Home environment and support contours and develops learning in students. Students become less attentive and academic performance is affected if the home-related factors are not

Figure 1: Types of factors affecting academic performance”


Demographic Data Frequency Percentage

94

106

Female 200 100

100

Age: 17-20 yrs21-24 yrs

Education: BScNGN

50

50

47

53

100

RESULTS

Table 1. Demographic Data

This section presents the prole of the respondents and outcomes of the study.


and they can even withdraw from the research anytime if they want. They were explained that their information will be kept condential, no names or numbers will be published and they will be given codes instead. Participant's right to n o n - m a l e c e n c e w a s m a i n t a i n e d ; t h e participants didn't have any harm from this research.

The setting of this research was the nursing college of the teaching hospital. Quantitative cross-sectional study design was used in this research. The population under study were the nursing students of college of Nursing, of the teaching hospital. The data was collected through convenient sampling.The research tool used is an authentic, well organized questionnaire with close ended questions in it , as per the likert scale. Questionnaire was taken from the prior research article “Factors affecting the academic performance of the student nurses in BSU.”. The questionnaire consists of the closed ended questions that are related to the factors; personal conditions of the student, study habits, family-related, school-related and teacher-related aspects. The Cronbach's alpha reliability of this questionnaire is 0.798.This study was held keeping in view all the ethical considerations. Permission was taken from Faculty of Allied Health Sciences, Department of Lahore School of Nursing and the principal of the nursing college of the teaching hospital. The purpose of research was informed to the participants and they were guided about all the information regarding research. The informed consent was signed by nursing students. Participants were informed that they have a right to participate or not to participate

suitable for students. Study habits of the students explore the behavior of the student towards studies. Hence, study habits have a strong inuence on academic performance. Personal conditions are personal issues of the student that may regard to mental or physical health. Personal conditions have a powerful impact on the academic performance of nursing students.

Aim of the StudyThe aim of this research was to ascertain the factors that are affecting the academic performance of the students in nursing education.

Table No. 1 shows that 47% students were between 17-20 years of age, 53% of the students were between 21-24 years of age. 50% students were BScN students and 50% were of general nursing.

Factors NI VLI LI HI VHI

I study only when there is aquiz

N

N

%

%

13 30 52 64 41

6.5 15 26 32 20

I feel tired, bored and sleepy

18 20 58 76 28

9 10 29 38 14

I prefer listening to radio, watching TV, etc.

N

%

17 31 48 67 37

8.5 15.5 24 33.5 18.5

Table 2. Study Habits


MARTIAL & METHODS

N

%

I am too lazy to study

27 35 42 68 48

13.5 17.5 21 34 14

I am disturbed when studying

N

%

29 32 54 53 32

14.5 16 27 26.5 16


Table No. 2. shows that the 32% students believe that studying only when there is a quiz affect the academic performance of nursing students and it has a high impact on the academic results. 26% nursing students believe that studying only when there is a quiz has a low impact on academic performance. 13 (6.5%) students believe it has no effect on the academic performance of nursing students. 38% students agree that feeling tired, bored and sleepy while studying have high impact on their academic performance. 29% students agrees that it have low impact while the 9% students agreed that it feeling tired, bored and sleepy doesn't have any i m p a c t o n a c a d e m i c p e r f o r m a n c e o f undergraduate nursing students. 33.5% students believed that preferring listening to radio, watching TV, etc. have a high impact on academic performance of nursing students. 48 (24%) students claimed that it has low impact and 8.5% students claimed it has no affect at all. 34% students agreed that being too lazy to study have high impact and affects the academic performance of the nursing students. The higher percentage of students that is 27% believed that being disturbed when studying have a low impact on academic performance while 26.5% believed it have high impact. 14% students being disturbed when studying have no impact on the academic achievement. 24.5% students revealed having no time to study at home have low impact while 19.5% says it has high impact on academic

performance of nursing students. 27.5% students stated that having no time to study at home have no impact on academic performance and don't affect academic results of students. 24.5% students revealed having no time to study at home have low impact while 19.5% says it has high impact on academic performance of nursing students. 27.5% students stated that having no time to study at home have no impact on academic performance and don't affect academic results of students.Majority of the students think studying only when they like has very high impact on the academic performances. Only 8% students stated that it doesn't have any impact on the academic performances of the nursing students.77.5% revealed that don't having a comfortable place to study have a very low, low, high or very high impact on academic performance of nursing students. While the 22.5% students revealed that it has no effect on academic performance of nursing students. Copying the assignments of the friends, have a very high impact on the academic performance of nursing students. 13% students stated that coping assignments doesn't have any affect while the greater percentage of students


N

%

29

14.5

Feeling sleepy in the class

23 36 63 49

11.5 18 31.5 24.5

Feeling hungry in class

N

%

17 41 44 59 39

8.5 20.5 22 29.5 19.5

Difculty in sleeping

N

%

58 38 43 27 36

29 18 21.5 13.5 18

Difculty in hearing

N

%

100 38 20 31 11

50 19 10 15.5 5.5

Difculty in breathing

N

%

114 21 36 9 20

57 10.5 18 4.5 10

Table 3. Personal Conditions


*NI; No impact: VLI; Very Low Impact: LI; Low Impact: HI; High Impact:VHI; Very High Impact

I copy the assignments of friends

N

%

26 31 36 50 57

13 15.5 18 25 28.5

I study only when I like

N

%

16 20 36 63 65

8 10 18 31.5 32

I don't have a comfortable place to study

N

%

45 41 45 45 24

22.5 20.5 22.5 22.5 12

I have no time to study at home

N 55 32 49 39 25

% 27.5 16 24.5 19.5 12.5

Table No. 3. shows that 31.5% students responded that feeling sleepy in the class have a high impact on the academic performance of the nursing students. 14.5% students stated that


feeling sleepy in class has no impact on academic performance of the nursing students. Feeling hungry in the class have a high impact on the academic performance of the nursing students (29. 5%). 22% students stated that feeling hungry in class have low impact on academic performance. 8.5% suggested it has no impact on academic achievement. 29% nursing students stated that difculty in sleeping has no impact, 21.5% nursing students stated low impact, 18% nursing students stated very low and high impact and 13.5% nursing student's stated high impact, on academic performance. According to this table, 50% of the nursing students revealed that difculty in hearing has no impact on academic performance. Whereas, 50% students stated that difculty in hearing affects the academic performance of the nursing students. 114 (57%) students claimed that difculty in breathing doesn't affect their academic performance. The rest of the students (43%) claimed that it has some effect on academic performance.

Table 4. Home Related Factors


N

%

18

9

I live far from school

28 33 28 93

14 16.5 14 46.5

I live near the school

N

%

64 24 36 37 39

32 12 18 18.5 16.5

I don't live with my parents

N

%

64 19 23 28 66

32 9.5 11.5 14 33

Both my parents are working

N

%

59 31 27 59 24

29.5 15.5 13.5 29.5 12

I do too much households

N

%

27 61 21 65 26

13.5 10.5 30.5 32.5 13

I have many brothers and sisters

N

%

40 36 32 65 27

20 18 16 32.5 13.5

doesn't have any effect on academic performance of nursing students. According to 32% participants students' academic performance is not affected by living near the school, 19.5%, 18.5%, 18% and 12% students stated living near the school have very high impact, high impact, low impact and very low impact. 33% students revealed that not living with the parents have very high impact on academic performance and 32%students say it have no impact on the academic performance of undergraduate nursing students. 70.5% nursing students stated that both parents working have a very low, low, high or very high impact while 29.5% stated that it have no impact on the academic performance of the undergraduate nursing students. majority of the participants (32.5%) think that doing too much households have a high impact on their academic performance. 13.5% participants think doing toomuch households don't affect academic performance of nursing students. 65 nursing students (32.5%) declares that having m a n y s i b l i n g s h a v e h i g h i m p a c t o n undergraduate nursing students' academic performance. 40 students (20%) declares that it has no impact.


Table No. 4.46.5% nursing students agreed that living far from the school affect and have the very high impact on the academic performance of the nursing students and 9% students stated that it

Table 5. School Related Factors


N

%

39

19.5

The time schedule is followed

27 54 53 27

13.5 27 26.5 13.5

There are school programs

N

%

29 42 43 64 22

14.5 21 21.5 32 11

There are available library references

N

%

44 44 36 49 27

22 22 18 24.5 13

Classroom is comfortable enough

N

%

25 27 40 69 39

12.5 13.5 20 34.5 19.5

There is fast internet access in the library

N

%

71 23 32 36 38

35.5 11.5 16 18 19


N

%

20

10

Teachers has the mastery of the subject matter

23 46 66 45

11.5 23 33 22.5

Teachers discuss manytopic in a shortperiod of time

N

%

29 13 37 69 52

14.5 6.5 18.5 34.5 26

Teacher uses audio visual aids

N

%

16

8

18 52 74 40

9 26 37 20

N

%

25 18 59 44 54

12.5 9 29.5 22 27

Teacher gives too much memory work

Teacher provide varied activities %

N 25 18 59 44 54

12.5 9 12.5 22 27

Teacher uses lecture methods only %

N 25 30 55 63 27

12.5 15 27.5 31.5 13.5

Teacher always scold students %

N 36 34 27 65 38

18 17 13.5 32.5 19

Teacher is frequently out/absent from class %

N 32 31 50 63 40

16 15.5 25 31.5 12

Table 6. Teacher Related Factors


students believe that having enough space in library has a very low impact on their academic performance similarly, 15% said that it has a low impact. However, 24% of nursing students said that it has high impact and 27.5% of students revealed that it has a very high impact on academic performance. Location of classrooms according to 8.5% students has a very low impact and according to 23.5% nursing students it has a low impact on their academic performance as a matter of fact 35% nursing students believed that it has high impact and 19% of nursing students stated that it has a very high impact on academic performance.

Table No. 5. According to this table 13.5% nursing students believe that following the time schedule has a very low impact. Similarly, 27% students state that following the time schedule has low impact. Although 26.5% nursing students believe that following the time schedule has a high impact on academic performance while, 13.5% of students say that following the time schedule has a very high impact. 21% of the nursing students believe that conducting school programs has a very low impact on academic performance of students. Similarly, 21.5% students say that it has a low impact on academic performance. However, 32% nursing students stated that organizing school programs has high impact on academic performance and 11% believe that school programs have very high impact. 22% of the nursing students believe that available library references for their study material have a very low impact similarly 18% of the students agree upon that references have very low impact. However 24.5% of the nursing students have a say that available library references for their study purpose or research work have a high impact. Meanwhile, only 13.5% of the students agree upon that available references have a very high impact. According to 13.5% of nursing students' comfortable classrooms has a very low impact on academic performance while 20% said it has a low impact. Similarly, 34.5% of nursing students stated that it has high impact while 19.5% of students revealed that it has a very high impact on nursing students. 11.5% of nursing students stated that it has a very low impact in academic performance of students whereas 16% said it has a low impact. However, 18% of nursing students revealed that it has a high impact similarly 19% of students stated that it has a very high impact on their academic performance. 13.5% of nursing

Table No. 6.11.5% of nursing students said that teacher having the mastery of subject matter has a very low impact. Similarly, 23% of students revealed that it has a low impact. However, according to 33% nursing students teacher


There is enough space in the library

N

%

40 27 30 48 55

20 13.5 15 24 27.5

Location of classrooms

N

%

28 17 47 70 38

14 8.5 23.5 35 19


students have a very high impact. 15.5% of students revealed that this do affect with a very low impact on academic performance of nursing students similarly, 25% said that it has a low impact. As a matter of fact 31.5% nursing students believed it has a high impact while, 12% of nursing students agree upon that it has a very high impact on academic performance. 10% of students think that it has a very low impact whilst 13.5% nursing students said it has a low impact. On the other hand 33.5% of nursing students believed it has a high impact, teachers being late do affect the academic performance of nursing students and 17.5% students believed that it has a very high impact on nursing students.

having the master of subject has a high impact on academic performance of students whereas, 22.5% of nursing students stated that it has a very high impact. 19% of the students believe that it has a very low impact on academic performance whilst, 24.5% nursing students stated that it has a low impact. On the other hand 33.5 % nursing students said that it has a high impact on academic performance and 23% nursing students believe that using audio visual aids ha a very high impact. 6.5% of nursing students revealed that it has a very low impact on academic performance whereas, 18.5% said it has a low impact on academic performance. However, 34.5% students revealed that it has a high impact on academic performance and 26% nursing students believed that it has a very high impact.,9% of the nursing students believe that teachers' giving to much memory work has a very low impact while 26% of students stated that it has low impact. Although 37% of nursing students believe that it has a high impact on academic performance of students. Similarly, 20% of students have a say that it has a very high impact. 9% of nursing students stated that varied activities have very low impact and 29.5% students believe that teachers' providing varied activit ies has low impact on academic performance. On the other hand 22% of students believed that providing varied activities has high impact meanwhile, 27% students say that it has a very high impact on academic performance. 15.5% of nursing students stated that teachers using lecture methods only has a very low impact whereas, 28% think that it has a low impact on academic performance of nursing students. However, 25.5% students believed that using lecture methods only has a high impact and 13.5% students agreed that teachers using lecture methods only has a very high impact on nursing students. 17% of nursing students believe that it has a very low impact and 13.5% ofstudents said that it has a low impact on academic performance of students. 32.5% nursing students revealed that it has a high impact whereas 19% said teacher scolding

DISCUSSION

This research has been conducted to ascertain the factors affecting the academic performance of undergraduate nursing students. The data had been collected and analyzed of 200 female undergraduate nursing students from College of Nursing, Allama Iqbal Medical College. The participants are 100 (50%) BSN and 100 (50%) general nursing students. Five factors have been discussed in this research. According to analysis of the rst factor study habits; the rst element shows a greater impact. 187 (93.5%) students responded that studying only when there is a quiz affects the academic performance of the undergraduate nursing students. 184 (92%) nursing students revealed that studying only when they like affect academic performance of the nursing students. Among the ve elements of the personal conditions 85.5% and 91.5% students revealed that feeling sleepy and feeling hungry in the class affects the most. According to the results of home related factors, I live far from the school has the highest affecting element according to 91% (182) students. Acknowledging the school related factors; classroom is comfortable enough have the highest percentage of the students (87.5%). Furthermore, teacher related factors have the highest impact among all the other variables. The 90% students revealed



DISCUSSION

The limitations of this study are:1. This research has been conducted for undergraduate nursing students to identify and overcome the factors affecting their academic performance but can be used by students of other disciplines as well.2. Due to the lack of the time and ongoing classes, the data may not be lled correctly or may be lled in hurry.

teacher has the mastery of the subject, 100% students revealed teacher discuss many topic in a short period of time, 85.5% said teacher uses audio visual aids, 92% revealed teacher provide varied activities and 92% said teachers give too much memory work contributes the highest impact on the undergraduate nursing students' academic performance. The interpretation of the result analysis assured that there are plenty of factors affecting the academic performance of the undergraduate nursing students. Among which teacher related factors are most signicant. The second most signicant factor is the study habits of the students that affect their academic achievement. The third ranked are the personal conditions of the students. Home related factors are the fourth important in uencers. The school r e l a t e d f a c t o r s a r e r a n k e d t h e l a s t .Various studies had supported these factors affecting the academic performance of the students. in the study stated copying the assignments of others or studying when there is a test affects the academic performances immensely and briey described that feeling sleepy in class or difculty in sleeping affects the students' academic progress and learning abil i t ies . According to the academic performance of students is affected by the school related factors if they are not favorable. According to study of ' 100% of the participants strongly agreed that school related factors a such as library facilities, classrooms location and comfort affects the academic performance of the students. Most of the correspondents agreed that school resources play a vital role in achieving students' good academic results. contributed to it by stating that the lack of mechanism, resources or teaching styles used by the teachers as effective teaching affects the students' academic performance negatively reducing their effectiveness for future career plans. 87 % of the correspondents stated that, the availability of the resources like internet, library, and laboratories might have a positive inuence on academic performance of the nursing students. discussed in their study that teacher related factors have the

ConclusionFrom the current study, it has been concluded that there are multiple factors affecting the academic performance of the nursing students. Good academic performance is an essential element for achieving the future goals and competency . The ve fac tors that are contributing a major role in affecting the academic performance of nursing students are study habits, personal conditions, home related factors, school related factors and teacher related factors. Among all of the ve factors, teacher related are of the highest signicance. Student's personal interests are also playing important role which are considered as study habits of the students. Student's academic performance can be enhanced by reducing these factors contributing to it.

Recommendations:The following strategies are recommended to overcome these factors; a)The institutes must focus on the factors affecting the academic performance of the nursing students. b) The students should identify the factors and eliminate them and improve their academic performance. c) The seminars should be conducted to create awareness regarding these factors affecting academic performance.d) Seminars on the different teaching and learning s t r a t e g i e s s h o u l d b e c o n d u c t e d . AcknowledgementFirst and foremost, I am profoundly thankful to,


highest impact on the academic performance of the nursing students.

Hijazi, S. T., & Naqvi, S. (2006). FACTORS

A F F E C T I N G S T U D E N T S ' PERFORMANCE. Bangladesh e-journal of

2002. National Center for Family and Community Connections with Schools.


God Almighty for giving me the strength to conduct this research.This study is dedicated to my beloved family for their patience, moral and nancial support. Very special thanks to Mr. Afsar Ali and Mr. M Afzal for their guidance and time. I pay my humble gratitude to the participants and the institute for their precious time and co-operation.

Adeyemi, B. (2010). Teacher-related factors as

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ABSTRACT

Correspondence Address IntroductionJob satisfaction enables the organization with greater productivity. Satised employees at the workplace efciently fulll the ever-changing demand of the health care sector. Studies show that job satisfaction can be achieved through motivation. In highly demanding health care setting motivation plays a key role to keep the employee satised. Extrinsic motivation in the form of rewards, work environment and promotion ensures the employee's satisfaction. Further, job satisfaction is inuenced by the environment at workplace. Thus, it was the need of time that the issues of health care sector employees must be considered. Therefore, main objective of the study was to investigate the impact of extrinsic motivation like rewards, work environment and promotion on nurse's job satisfaction in services hospital Lahore.

MethodsThe is descriptive cross sectional study design and the data was collected through self-administered questionnaire from staff nurses of tertiarry care hospital Lahore, Pakistan. The sample size of the current study was 205 staff nurses and selected through simple random sampling technique.

Impact Of Extrinsic Motivation On Job Satisfaction Among NursesKousar Perveen, Assistant Professor, Lahore School of Nursing, The University of Lahore, Pakistan.

Iram Majeed, Lecturer, Lahore School of Nursing, The University of Lahore, Pakistan.

Results The results of structural model showed that there is a signicant positive relationship among rewards, work environment, promotion and nurse's job satisfaction. In addition, rewards and work environment has more signicant and positive relationship with nurses' job satisfaction.

ConclusionThe current study concludes that extrinsic motivational factors increase the job satisfaction of the nurser's of health care sector. However, the current study provides the insights to the policy makers of the health care sector regarding key factors for nurse's job satisfaction. Likewise, the study results will lead the health care sector to achieve the strategic objectives.

Keywords Job satisfaction, Extrinsic Motivation, Work environment, Promotion, Rewards, Nurses,

Health care sector

Kousar Perveen, Assistant ProfessorLahore School of NursingThe University of Lahore, [email protected]

Nursing as a profession is an integral part of health care system that includes promotion of health and prevention of illness of all ages and gender (WHO, 2012). Therefore nurses are the back bone of any health care organizat ion (Needleman & Hassmiller, 2009).

In highly demanding health care setting motivation plays a key role to keep the employee satised. Job satisfaction enables the organization with greater productivity. Nurses who are satised with their job are responsible for providing quality care to the patients. Satised employees a t the workplace e fc ient ly

Muhammad Jafar, Assistant Professor, Institute of Nursing, Dow University of Health Sciences Karachi, Pakistan.

INTRODUCTION


Extrinsic Motivation On Job Satisfaction

fulll the ever-changing demand of the health care sector. While the concept of job satisfaction is widely studied in the elds of psychology, sociology and organizational behavior. Several studies dene job satisfaction as a persons' attitude toward life and its effect on his/her life as whole (Mazerolle et al., 2008).Job satisfaction is an employee's satisfaction with the feelings of success achieved from the job (Yilmaz, 2002). Job satisfaction is the match between an individual's expectations and the perceived reality of the job as a whole (Wang and Tran 2015).According to Bahalkani et al., (2011) satisfaction is the level at which workers like their jobs. Job satisfaction enhances the efciency, creativity and quality of work in an organization. In health care setting, job satisfaction among nurses is necessary for fu l l l l ing the ro le and responsibilities of patient's care. Job satisfaction is most researched topic in abroad as well as Pakistan; an organization can be highly productive by attaining the maximum level of job satisfaction. In the health care setting, job satisfaction of nurses has signicant inuence on organizational outcomes. (Bahalkani et al., 2011).Studies show that job satisfaction can be achieved by motivation (Singh, 2012) Motivation is essential for attaining the job satisfaction among nurses. Nurses satisfy with their jobs by extrinsic and intrinsic motivation. Extrinsic motivation in the form of reward like, Salary, benets, promotion, compensation, positive f e e d b a c k f r o m s u p e r v i s o r , w o r k i n g environment, power and intrinsic motivation like achievements, need for afliations, job security, responsibilities, recognition is essential factor for achieving the basic objectives of an organization. Lack of motivation makes the employee unsatised and they leave the organization. (Farooq & Hanif, 2015).Extrinsic motivation is form of motivation that is external to job.Extrinsic motivation in the form of reward for good work makes the people motivated. Likewise, supervision, benets, aspiration from

coworkers and better working environment all are used to motivate the employees externally (Kumar, 2011)

Nursing is a profession of providing care to the ill patients. Nursing profession is rated among the most reliable and trusted professions in the world (Olshansky, 2011).In hospital while providing care, there is high emphasize on nurses job satisfaction.According to job satisfaction in any healthcare organizations play very important role which effects performance of any organization. Satised and committed employees are the need of every organization. Therefore for the success of any organization it is necessary to enhance the satisfaction level of employees (. According to Singh (2012) job satisfaction can be achieved through motivation (Singh, 2012).Several studies supported the idea that job satisfaction is crucial to enhance the productivity of health care setting and can be achieved by offering rewards like handsome salaries, fair promotion system and providing suitable work environment to hospital employees. (Jasiwal et al, 2015). Findings of study by Byron and Khazanchi (2010) showed the positive relationship between extrinsic motivation and job satisfaction. Job satisfaction is the difference between the reward and considered demand by employees. (Adenuga, 2015)Job satisfaction is a state of behavior where an employee feels pleased, motivated and eager by performing his/ her job related tasks (Johnson & Sohni, 2014). According to Mathauner et al, (2006) various factors have been recognized such as salary, training, the working environment; supportive supervision and recognition that inuence the employee satisfaction with job.Success level in providing patient care relates positively to job satisfaction. Results of the study show dissatisfaction of nurses with their work and organization due to low salary packages. The research also concluded that motivation is



showed that quality work of an organization depends on the job satisfaction of the employees. The key factors of job satisfaction are justice in promotion to the next level, good salary packages and supervision. Money is a best motivator for making the employee more devoted to organization. .According to Employees of any organization are greatly inuenced by its work environment. Employees working in a favorable working condition have positive perception toward organization. Moreover work environment also involves factors related to work place such as the qua l i ty o f communica t ion ows , sa fe environment , contro l lab le work load , supervision and other additional bonuses and benet of employment. . Job satisfaction is inuenced by the environment at workplace (Kreitner et al., 2002). According to supervision of employees to perform organizational duties will make the employee obliged and more committed towards organization. Open communication keeps employee happy and satised. When employees of an organization work together, level of satisfaction is achieved .Smith (2002) suggested that job satisfaction is enhanced by providing working environment t h a t o f f e r s t h e e m p l o y e e s w o r k i n g autonomously and with full courage while remain unproductive under restrictive work environment. The nding of study conducted by Ayers (2005) shows organizat ional miss ion and job satisfaction should be achieved by enhancing work conditions that enable the employees to perform at their best.The Guardian (2015) described that in 2000 to 2011 approximately 233,000 suicides were committed due to job linked issues (Adewale, 2015).The purpose of this study is to assess the impact of extrinsic motivation on job satisfaction among nurses. The impact will be assessed through extrinsic factors like reward (Salary & benets), p r o m o t i o n a n d w o r k i n g e n v i r o n m e n t

necessary because it positively affects job satisfaction and to motivate nurses, external factors like timely promotion, rewards, nancial benets, handsome salaries and job security are essential. (Edoho et al., 2015) Findings of study conducted in South Africa by Pillay (2008) on professional nurses depicted that nurses working in the public hospitals were dissat ised with salaries and material resources.Committed employees become the integral part of an organization when they work toward the betterment of it. Commitment enhance the job satisfaction which in turn inuenced by rewards and promotion (Woods et al., 2004) Another, study by Bhaduri (2011) showed that reward in the form of appreciation makes the employee motivated for his/her organizational task. Other extrinsic motivators like positive response from the mangers and good working environment are also important but rewards play a vital role in achieving the optimal level of job satisfaction. The study further elaborated that job security; salary and reward are the most important motivational factors for job satisfaction in health care o r g a n i z a t i o n ( B h a d u r i , 2 0 1 1 ) .Study conducted by Eisenberger, Haskins and Gambleton (1999) shows that employee performance can be enhanced by increasing monetary rewards like salaries Flynn (1998) suggested that job satisfaction of employees can be enhanced by providing the rewards i.e pay contingent to performance. Reward programs made the employees enthusiastic and their high morale leads toward high performance and job satisfaction.Findings of a study in Pakistan proved that the reason for dissatisfaction of respondents with their jobs are poor working conditions, less rewarded work, low salaries and lack of economic rewards. Job satisfaction increases the productivity of health care setting. Nurses satised with their job provide best care services to the clients in health care setting (Bahalkani et al., 2011). A study conducted by Perveen and Kabir (2011)

The results section comprises on three main parts. In rst part demographic characteristics of respondents is being discussed. The second part discusses about the validity and reliability of data, which are measured using conrmatory factor analysis. The last part of this section explains the statistical results of structural model to describe the hypotheses. Demographic Characteristics of Respondents.The frequency distribution of respondent's proles is shown in Table 1. It is evident from the numbers shown in table that all the respondents in this study are from one gender that is “female”. The reason behind this single gender response is the stereotypical image of nursing profession. In Pakistan, it is a common belief that nursing is the job of female and male should not adopt this profession, however, the trend is started changing in recent years. All of the respondents hold diploma in nursing which is the basic requirement of this profession in our country. The age distribution of respondents is not shocking and we received the expected response. Most of the respondents are younger than 35 years of age and only a small portion fall in the age bracket of 36-50 or 50 and above years. This is because mostly female employees leave their job when they have to perform the ob l iga t ion o f growing the i r ch i ldren .

RESULTS



(supervision, communication and relation with coworkers).

Aim of the StudyThe aim of this study is to assess the impact of extrinsic motivation on job satisfaction among nurses.

The descriptive cross sectional study design was used to assess the impact of extrinsic motivation on job satisfaction among nurses. Target population of the study was 420 staff nurses of tertiary care hospital. The inclusion criteria was all indoor staff nurses working in services hospital Lahore. Exclusion criteria of study was all staff nurses working in emergency, outdoor, ICU and Operation Theater. Sample size was 205 staff nurses calculated according to Solvins' formula (n= N/1+N (E) 2) for sample size. The research was conducted in Service Hospitals Lahore. Simple random sampling technique was used for data collection in which each participant has an equal chance to become the part of the study. The chances of error are less in simple random probability sampling technique compare to non-probability sampling techniques.Data was collected from nurses through self-administered questionnaire. Scale for measuring job satisfaction is adapted from Churchill et al, (1974) and for extrinsic motivation from Spector (1997). Questionnaires have ve point Likert scale for data collection i.e. 1. (Strongly disagree) 2. (Disagree) 3. (Neutral) 4. (Agree) 5. (Strongly agree). It was distributed to nurses of Services Hospital Lahore. Time frame of the study was 6 months from January, 2016 to June, 2016.Participant was informed about the purpose of the study and any misperception regarding the study was claried. Permission letter was signed from the medical superintendent of Services hospital Lahore before collecting the data. Data collected from this study only used for research purposes and kept in full condentiality. Informed consent was used to have the agreement of be a part of research.

MARTIAL & METHODS

S# Demographic Characteristic N %

1

2

3

205 100%

GENDER

Female

Male

205 100%

0 0

Qualication

Diploma

Others

205 100%

0 0

Age Group

18 _25 Year

26 _35 Year

36_50 Year

78 38.0%

117 57.1%

10 4.9%

Table 1 Demographic Characteristic



Conrmatory Factor AnalysisThis study employed conrmatory factory analysis to conrm the validity and reliability of the data. The results of conrmatory factor analysis are represented in Table 4.2. The validity of the data is measured using two indicators “standardized factor loadings of each question item” and the value of “average variance extracted of each variable”. The results of measurement model as presented in Table 2 depict that all the measurement scales have successfully fullled the requirements of reliability and validity as recommended by Hair et al. (2010) and Fornell and Lacker (1981).

Table 2 Results of Conrmatory Factor Analysis

Scale & ItemsFactor

Loading AVECronbach’s Alpha

Job Satisfaction

My job is satisfying

0.589 0.59 0.900

My job is exciting 0.787

Gives sense of accomplishment 0.821

Doing something important 0.864

I feel valued at work. 0.759

I feel involved in decision 0.769

PromotionSatised with my chances for promotion

0.740 0.52 0.854

There is really too little chance for promotion 0.773

Continually advance to more senior position 0.642

Stand a fair chance of being promoted 0.715

People get ahead as fast as they do in other places. 0.728

Reward

Paid a fair amount for work I do

0.660 0.54 0.874

Unappreciated by the organization 0.867

I feel satised with my chances for salary increases. 0.673

My supervisor gives me regular, timely feedback 0.853

Communication seems good within this organization 0.624

The goals of this organization are not clear to me.

0.602

I am not satised with the benets I receive

0.672

The benets we receive are as good as others 0.646

Benets we receive are as good as other organizations offer. 0.856

Work Environment

My supervisor is quite competent

0.816 0.52 0.902

My supervisor inspires me. 0.846

4

Above 50 Year 0 0

Stay in organization

Less than 1Years

1- 5 Years

6-10 Years

Above 10 Years

10 4.9

72 35.1

116 56.6

7 3.4

There is too much bickering and ghting at work.

Work assignments are not fully explained. 0.623

I enjoy my coworkers. 0.674

0.655

The validity is veried by two ways; rstly, all the standardized factor loadings are greater than 0.5 as presented in Table 2 which indicate that all the items are converged at same point. Secondly, the Average Variance Extracted (AVE) is also greater than 0.5 for all the measurement scales. Hair et al. (2010) asserted that the value of AVE and standardized factor loadings should be greater than 0.5 to meet the criteria of validity.The table shows the results of validity and reliability. The values of factor loadings, average variance extracted and Cronbach's alpha indicate that our data is valid as well as reliable for further analysis. In addition, the physical representation of conrmatory factor analysis in shown in gure 1.

This study utilized structural equation modeling technique to statistically test the formulated hypothesis. Structural equation modeling is the recent and most commonly used statistical technique to test the multiple hypotheses simultaneously. Structural equation modeling is employed using SPSS-AMOS-22 version. The results of structural model are presented in Table 3 and Figure 2. The detailed explanation of these results is given below:

Figure 2: Structural Model



Figure 1: School Related Factors

H Causal Path

β S.E B T p Results

H1

H2

H3

PRàJS

RWDàJS

WEàJS

.126

.183

.625

.057

.043

.088

.130

.251

.696

2.226

4.273

7.113

0.026

0.000

0.000

Accepted

Accepted

Accepted

Table 3: Statistics of Structural Model

2N=205, P<0.05, R =0.677 The hypothesis H1 (There is signicant positive impact of promotion on nurse's job satisfaction) is signicantly supported as the results of SEM analysis presented in Table 3 show that the job satisfaction will increase 0.126 units with one unit increment in promotion as β = 0.126 and p = 0.026. Therefore, it can be said that when a health care institute increase the chances of promotion the job satisfaction level of nurses started increasing. Promotion is has signicant importance in the career of any indiv idual e i ther in serv ice sec tor or manufacturing sector, same is the case with

health care sector, in this sector nurses consider promotion among one of key drivers of long term success in their careers . Addit ional ly , Promotion, Rewards and Work Environment collectively explain 67.7% variance in the level of job satisfaction of nurses as the value of R2 is 0.677.

Therefore, it is inferred that promotion, rewards and work environment play very crucial role in increasing and decreasing level of job satisfaction among nurses of health care sector in Pakistan.The hypothesis H2 (There is a signicant positive impact of reward on nurse's job satisfaction) is also signicantly supported by results of structural model. The values of structural model's statistics as presented in Table 5.3 indicate that job satisfaction of nurses will increase by 0.183 units with one unit increase in the level of rewards and benets provided to nurses β = 0.183 and p = 0.000. This reveals that rewards and benets have substant ial contribution towards maintaining high levels of job satisfaction among nurses. Everyone, working in any sector or eld receives rewards either in the form of money, bonuses, shares, and housing & transportation facilities, so, everyone considers these things worthy of motivation.



Therefore, it is inferred that if the administration of hospitals increase the value of rewards provided to nurses the level of job satisfaction of nurses can be increased signicantly. This increased job satisfaction can generate substantial revenues for health care sector as well as better services for patients. The hypothesis H3 (There is signicant positive impact of work environment on nurse's job satisfaction) is signicantly supported by the statistical indicators. The values of SEM coefcients depict that the level of job satisfaction increases with 0.625 units with one unit increase in work environment as β = 0.625 and p = 0.000. The value of beta indicates that nurses in health care sector of Pakistan consider work environment most important as compared to other indicators of job satisfaction. The work environment in health care sector of Pakistan is not very good as compared to developed countries in the world. Therefore, nurses want improvement in work environment of hospitals. If health care sector of Pakistan try to improve the work environment it can yield substantial increase in revenues as well as good will.. If health care sector of Pakistan try to improve the work environment it can yield substantial increase in revenues as well as good will.

DISCUSSION

are one of the most important players because they are the one who spend more time with patients. As patients are the customers of any hospital therefore all the revenues came from them. In marketing it is believed that “customer is the boss” and if the boss remain satised your organization will remain in operations forever. Therefore, one cannot underestimate the role of nurses in patient's care. If nurses remain satised with their jobs they will make the patients (customers) satised with their services. Therefore, the purpose of this study was to measure the level of satisfaction among nurses in health care sector of Pakistan. For this purpose this study chosen extrinsic motivational factors (reward, work environment and promotion) to invest igate their relat ionship with job satisfaction among nurses of Services Hospital Lahore. The results of this study showed that extrinsic motivational factors are signicantly related to nurse's job satisfaction. The nding of this study is consistent with results of study conducted by Byron and Khazanchi (2010) which showed the positive relationship between extrinsic motivation and job satisfaction. Hence, it is found that to increase the level of satisfaction the mot ivat ion p lays s ign icant ro le . The relationship of job satisfaction with motivational factors which are extrinsic in nature like promotion, reward and work environment are examined in the study and discussed separately. Findings from this study indicate that there is a signicant positive relationship between reward and nurse's job satisfaction. These ndings are parallel with statistical outcomes of )'s study on job satisfation and motivation. Their study revealed that most of the respondents were dissatised because of insufceint rewards they receive. Therefore, it is established that rewards play substantial role in nurse's job satisfaction. It is witnesed that a little increase in rewards can bring signicatn increase in the level of job satisfaction among nurses in health care sector of Pakistan. Like all other professions, the nursing profession has a well-dened career path which is followed

Technological advancements and latest innovations in almost all the elds have changed the nature of every work or job. Along with numerous positive aspects like efciency, effectiveness, and physical labor to mental work, these advancements brought some adverse effects which are causing health related problems. Health care sector is also working at its best to cure these novel issues. As the technological innovations captured all the sectors the health care sector has also adopted these innovations but these innovations demand more human intelligence, dedication and diligence. All the personnel in health care sector have signicant importance; therefore, nurses



by almost all the institutes in health care sector. The professional growth is always been the desire of any employee regardless the employment sector which he/she is working for, same is the case with nursing in Pakistan. The professional growth cannot be observed without proper mechanism of promotion in a specic career. Therefore, promotion plays an important role in the career progress of nurses in health care sector. This study investigated the impact of promotion on the level of satisfaction among nurses and found signicant results. The ndings revealed that promotion is one of the key drivers which increase the level of job satisfaction of nurses in Pakistan. Smiliarly, a study conducted in pakistan by ) found that majority of participant were dissatised with their job due to lack of promotion and reward. The ndings of our study are in line with previous literature, therefore, it is infered that promtion helps to full an employee's career growth needs which in return result in improved customer services and revenue generation process. The most important aspect of this study revealed w h e n w e e x a m i n e d t h e r o l e o f w o r k environement on job satisfation. The results of our study are somehow very impressive but different from general stereotypes. The work environement proved to be the most signicant and substantial variable that impacts the job satisfaction level of nurses in health care sector of Pakistan. When compared to rewards and promotion the variable of work environment brought more prominent values in mangnitude like beta value and signicance level. It is evedent from the statisitical values that nurses are more concerned about the working conditions they work in routine as compared to other motivational factors like rewards and promtion. The ndings of our study have been supported by the results of Ayers (2005)'s study outcomes. Ayers's study showed that job satisfaction should be achieved by enhancing work conditions that enable the employees to perform at their best. The ndings indicate that

working conditions in health care sector of Pakistan demand substantial changes because the working conditions in many hospitals are not at par with conditions of some other sector in the same country. Therefore, to achieve the higher levels of job satisfaction among nurses the health care sector needs to improve the conditions as well as other factors of extrinsic motivation like promotion and rewards. When it comes to better services, institutional reputation, long term corporate sustainability and protable operations then the role of personnel became more signicant and decisive. Therefore, in health care sector the role of nurses cannot be overlooked and the issues related to nursing profession should be dealt with more care and diligence. Now the focus has been shifted from product orientation to customer orientation therefore to keep the customers s a t i s e d w i t h y o u r o r g a n i z a t i o n t h e administration of health care sector should have to work for the well-being of its human resources. Hence, our study proved i t empirically that extrinsic motivational factors like rewards, promotion and work environment are signicantly and positively related with job satisfaction. Therefore, the organization can work to improve the working conditions, promotion mechanism and reward system to increase the level of job satisfaction among nurses. In result, health care sector would be able to reap the benets in shape of institutional reputation, sustainable operations and increased revenues. Following are the limitations of the study.

Participants of the study were feel hesitation and not interested in lling questionnaire.

1-

Limited time to have face to face meeting with study participants to explain any confusion.

2-

The study was conned to only one public hospital so the nding cannot be generalized.

3-

Resources for conducting research were 4-

AcknowledgementI am thankful to Allah who gave me the strength, condence, knowledge and without His blessings I might not have accomplished this research project successfully. After that I am grateful to my friends and colleague for their work and encouragement that helped me a lot in the completion of this project.



Based on the ndings of this study, the suggested recommendations are:

All health care organization should take the extrinsic motivational factors like reward, promotion and work environment as base of job satisfaction because only satised and motivated employee can make an organization more efcient and productive.

1-

Government and Policy makers should include the timely reward in the form of fringe benets and promotion system in service structure of nurses it will motivate the nurses towards their job which will also increase the quality of nursing care .

2-

An organization should provide a suitable 3-pleasant working environment to nurses which enhance nurse job satisfaction.

Job satisfaction of nurses should be enhanced by providing reward on nurse's g o o d p e r f or ma n ce , b y p r ov i d i n g opportunity of open communication and by providing good supervisory support.

4-

This study has small sample size and conducted in one hospital so large sample size is required to make its ndings more generalizable.

5-

Another similar study using observation method is recommended to examine the impact of extrinsic motivation on job satisfaction among nurses.

6-

ConclusionAccording to this study nding, extrinsic motivation has positive signicant relationship with nurse's job satisfaction. Rewards in the form of handsome salary and fringe benets have positive signicant impact on job satisfaction of nurses. By providing pleasant working environment to the nurses, they will feel condent, comfortable, work with their full heart

not sufcient which is hurdle in collecting accurate data and can cause biasness.

and show more job satisfaction. Therefore working environment has positive impact on job satisfaction. Promotion has less signicant impact on job satisfaction as compare to other two independent variables because salary and pleasant working environment are essential motivators for efciency and productivity of nurses at hospital settings.

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Employee Relations, Vol.26, No. 2: 137-150.



ABSTRACT

Correspondence Address IntroductionEmpowerment at workplace is important segment in professional development directly affecting organizational commitment. Nurses' empowerment affects the work productivity, work effectiveness, work satisfaction, patient outcomes and provides strong emotional connection with the organization.

MethodsDescriptive cross sectional study design was used. Sample size of 194 nurses from a public hospital of Lahore was selected. Random sampling technique was used for data collection. The inclusive criterion of study was all nurses working in indoor department and excluded the others. The questionnaires having ve point Likert scale was used to collect data. The data was analyzed by using Statistical Package for Social Sciences (SPSS).

ResultsResults showed that nurses' empowerment directly affects organizational commitment. Finding of study suggested positive relationship between nurses' empowerment and organizational commitment. Conclusions: It is conrmed that nurses' empowerment is positively related with organizational commitment.

Sarwat Noor, Post RN, BSN, Head Nurse, Sir Ganga Ram Hospital Lahore.

Impact of Workplace Empowerment on Organizational Commitment among NursesIram Majeed, Lecturer, Lahore School of Nursing, The University of Lahore, Pakistan

KeywordsEmpowerment, Nurses, Organization, Commitment.

highlighted the basic requirement to build up the nursing workforce in organization for improved health outcomes in the world (WHO, 2010) Nurses' empowerment in an organization helps to make decision, provide information and maintain the strong organizational commitment. (Karim & Noor, 2006)High level of commitment depends on empowerment. The independent decision making power provide motivation with the work and increases condence. Nurses who are empowered have positive impact on the organization. Empowered nurses stay in the

Empowerment is to give power or authority especially by legal or ofcial way. (British dictionary, 2008) Organizational commitment refers to the process and psychological attachment with the organization and works well to transfer information and achieve goals. (British dictionary, 2008) Organizational commitment describes the , feeling and Strengthresponsibility employee that an has towards the mission organization of the ( Dictionary ,2008)The World Health Organization has identied nurses as a health human resource and has

Iram Majeed,Lecturer,Lahore School of Nursing,The University of Lahore, [email protected]

Sarfaraz Masih, Associate Professor, Dow University of Health Sciences Karachi, Pakistan

INTRODUCTION

http://www.businessdictionary.com/definition/strength.html

http://www.businessdictionary.com/definition/responsibility.html

http://www.businessdictionary.com/definition/staff.html

http://www.businessdictionary.com/definition/mission.html

http://www.businessdictionary.com/definition/organization.html


positive correlation with organizational commitment (Scott et al, 1999).

organization even in devastating condition, accomplish their goal in the organization, make s t r o n g c o m m i t m e n t a n d l o y a l t y w i t h organization. (Chang et al, 2009) Nurses who are empowered have positive impact on the organization. Empowered nurses stay in the organization even in devastating condition, accomplish their goal in the organization, make s t r o n g c o m m i t m e n t a n d l o y a l t y w i t h organization. (Chang et al, 2009) Nurses having strong organizational commitment effort for the betterment of the organization, work efciently and make strong loyalty with the organization (Ambad & Bahron, 2012)Empowerment enhances the autonomy of the nurses. The job become meaningful and also the work become self-assured at job place. The empowerment provides the strong support to the organization and modies the nurses' behavior to increase the commitment. The empowered nurses can resolve the problem and promote cooperation with patient for providing better care. The nurses provide effective communication in a skillful atmosphere to enhance commitment with the organization (Kramer, Halfer, Maguire, & Schmalenberg, 2012)Empowerment increases the work productivity and provides strong emotional connection with the organization. The patient quality of care depends on nurses' empowerment. Many studies conclude that the nurse's empowerment have positive relationship with organizational commitment. (Leschinger et al, 2009)A nurse is crucial part in the organization. Nurses' having strong involvement at work support organization and enhance the effectiveness. Condence at job increases the organizational performance (Cho, Laschinger, & Wong, 2006)Empowerment is required is to improve the patient quality of care and make strong commitment with organization. (Leiter, Price, & Spence Laschinger, 2010)Organizational commitment depicts nurse's identication and participation. Strongly committed nurses want to stay longer and do better work in the organization. Their interaction with organization and work performance make

Studies show that nurses' work performance identication is helpful for strong orientation and commitment with organization. Nurses' empowerment is related to the workforce and is important in job and career. Nurses feel condent, self-assured and perform work activity well to fulll nursing responsibilities at job place. (Leschinger et al, 2014)Durai, (2010) described empowerment as one of the strategy used in organization for employee to make decision regarding different aspects related to job. Employee empowerment helps them in planning and performing job task with full devotion. Empowerment has also role in productivity of an organization (Durai, 2010)Empowered nurses become satised and committed with organizational polices. Nurses struggle to maintain the quality care of the patient. The empowerment has direct impact on the nurses' behavior, attitude, increase the quality care of the patient and develop strong relationship with organizational commitment (Kramer et al, 2012)Quality care of the patients is related to workplace empowerment. If the nurses are powerful they can deliver the best care to the c l i en t . Empowerment increase nurses performance with condence and enhance the work productivity related to the organizational commitment. Motivated nurses perform well and enhance organizational commitment with their efforts to make independent decisions at job place. Empowerment decrease job anxiety, decrease nurses' stress and enhance the organizational commitment with satisfaction (Leschinger, 2010).According to Wagner (2010) empowered nurses express condence and are successful care giver in clinical situation. Nurses perform a vibrant role in making healthy work environment and to enhance work satisfaction.Power is prerequisite for nurses at job place for improved patient care. Empowerment arises

Workplace Empowerment & Organizational Commitment



MARTIAL & METHODS

The study was carried out at services hospital LahoreA cross sectional study designed was used.Population of study was nurses working in

RESULTS

This section presents the outcomes of the study.

from collective structure in the workplace that facilitates nurses to be pleased, condent and perform efciently at the job (Wagner et al, 2010). Empowerment is essential segment in the work engagement and organizational commitment for the nurses. Studies show that the nurses' strong accessibility to workplace empowerment resulted in increased degree of overall work performance. Nurse's job satisfaction and d e c r e a s e j o b s t r e s s a r e t w o e f f e c t i v e c o n s e q u e n c e s o f i n c r e a s i n g n u r s e s ' empowerment and decreasing nurses' burnout. A study conducted to explore the relationship b e t w e e n n u r s e s ' e m p o w e r m e n t a n d organizational commitment revealed a signicant correlation. Finding of study suggested that a direct relationship exists in nurses' empowerment and organizational commitment. Result of the study also depicted that nurses' empowerment helps to modify work behavior and empowered nurses show positive attitude for organizational task. (Ibrahem et al, 2013).A study by Carman, (2011) to examine the a s s o c i a t i o n o f e m p o w e r m e n t w i t h organizational commitment among nurses showed empowerment as a motivational construct and a valuable tool for organizational commitment. Results of the study depicted that empowerment was highly associated with organizational commitment. Findings also

revealed that higher levels of empowerment will b e a s s o c i a t e d w i t h h i g h e r l e v e l s o f organizational commitment among nurses. (Carman, 2011)

Aim of the StudyAim of the study was to assess the impact of workplace empowerment on organizational commitment among nurses.

services hospital Lahore. Inclusion criteria ofstudy was all staff nurses working in indoor department and excluded the other nurses working in Services hospital Lahore.Simple random sampling techniques were used to collect data from selected population.Research InstrumentThe questionnaires having ve point Likert scale for data collection i.e. 1. (Strongly disagree) 2. (Disagree) 3. (Neutral) 4. (Agree) 5. (Strongly agree) adopted from (Allen &Mayer) was used.A formal written permission letter was signed by nursing Superintendent of services hospital Lahore for data collection. Pilot testing was done to check the reliability of instrument. Data was collected by primary investigator.Data was analyzed by social package for statistical sciences (SPSS).The data was collected from May, 2015 to June, 2015.Individual consent form was attached with questionnaire for taking the permission of p a r t i c i p a n t s . F u r t h e r m o r e , c o m p l e t e condentiality to the participants was assured. Participants were informed about the aim of the study.

S# Demographic Characteristic N %

194 100%

1

2

3

GENDER

Female

Male

Qualication

Diploma

Post

RNGeneric

Age Group

18 _25 Year

26 _35 Year

36_50 Year

178

16

172

7

15

44

100

48

Table 1: Demographic Characteristic

Table 3: Among Nurses Organizational

Commitment

Organizational commitment

S.D D N A S.A

The main reason for me to stay is that other hospitals won't necessarily provide better compensation and benets.

2.6% 11.3% 13.9% 41.8% 29.9%

The main reasons for me to keep working at this hospital are being loyal and ethical.

5.2% 5.7% 13.9% 29.9% 44.3%

I think that I have a strong emotional connection to this hospital

3.1% 2.6% 9.8% 44.3% 39.7%

I am glad that I am able to devote my future career life to this hospital.

3.6% 6.2% 17.5% 29.9% 42.3%

In the future, I will still feel proud of being a member of this hospital.

2.1% 3.6% 7.7% 44.8% 41.2%

I am happy to talk about my hospital with those

0 3.1% 12.4% 44.3% 39.7%

I strongly feel that I am part of the hospital.

6.2% 1% 8.8% 43.3% 40.2%

I think that staying at the same hospital will have better career development.

2.1% 1% 12.9% 52.1% 31.4%



Empowerment S.D D N A S.A

I am condent about my do job

2.1% 12.4% 42.8% 42.3% 99.5%

The work that I do is important to me.

0.5% 3.6% 6.7% 51.5% 57.1%

I have signicant autonomy at job.

1% 4.1% 8.8% 41.8% 43.8%

My impact on what happens in my department is large.

3.6% 5.7% 10.3% 50% 29.9%

My job activities are personally meaningful to me.

0 2.6% 9.3% 47.9% 39.7%

I have a great deal of control in my department.

5.7% 5.2% 8.2% 53.6% 26.8%

I can decide about doing my own work.

1.5% 2.5% 9.3% 36.5% 49.5%

I really care about what I do on my job.

0 1.5% 11.9% 35.6% 50%

My job is well within the scope

4.1% 2.6% 9.3% 27.3% 56.2%

Table 2: Among Nurses Empowerment

Less than 1Years

1- 5 Years

6-10 Years

Above 10 Years

20

101

40

33

Above 50 Year

4 Stay in organization

2

3.6%

I have considerable opportunity for independence and freedom

3.6% 10.8% 34.5% 46.9%

I have mastered the skills necessary for my job.

4.6% 3.6% 11.9% 39.2% 40.2%

My opinion counts in decisions

6.2% 6.2% 13.9% 19.6% 53.1%

The work I do is meaningful to me

5.2% 4.1% 10.8% 33% 46.4%

I have a chance to use initiative

2.6% 7.7% 9.3% 57.7% 21.6%

I am self-assured about my capabilities

1.5% 4.6% 9.8% 54.1% 29.4%

Corre la t ion o f the empowerment and

organizational commitment Table.

Table 4: Correlation Organizational

Commitment Empowered

EMPORG_

C OMIT

Pearson Correlation

1 .494**

194

.494**

Empowerment

Sig. (2-tailed)

N

Pearson

Correlation

.000

194

1


The cross-sectional study design as data was collected at one point in time. Small sample size Study was conducted at one hospital only.

ConclusionS t u d y r e s u l t s i n d i c a t e t h a t n u r s e s '

empowerment has pos i t ive impact on organizational commitment. If the nurses are

empowered they work condently and increase

the productivity of the organization. Results of

the study contribute to encouragement of the

empowerment as basic requirement in the

organization to enhance commitment.

AcknowledgementThe authors acknowledge the assistance of all the

nurses and nursing superintendent who

participated in this research.


Ambad, S. N. A., & Bahron, A. (2012).

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Cho, J., Las0chinger, H. S., & Wong, C. (2006).

Chang, L. C., Liu, C. H., & Yen, E. H. W. (2008).

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Effects of an empowerment-based

.000

194

Correlation is signicant at the 0.01 level (2-tailed).

ORG_COMITSig. (2-tailed)

N 194

DISCUSSION

Empowerment motivates nurses to make

positive behavior at the workplace. The study

demonstrated that empowerment has direct

impact on organizational commitment. If the

nurses are empowered at job place, they will stay

longer in the organization. According to Kramer

et al (2012) the empowerment has direct impact

on nurses work performance. Empowerment increase motivation and increase work

performance at their work. Nurses need

empowerment to improve their work in the

organization. (Kramer et al, 2012) The ndings of study indicated that impact of

nurses 'empowerment on organizational

commitment was s ignicant ly h igher .

A c c o r d i n g t o l i t e r a t u r e s u p p o r t t h e

empowerment s ignicant ly impact on

organizational commitment. Empowerment

helps nurses to show full commitment with the

organization and provides better care to the

patients. (Cho et al. 2006) Results show that

empowered nurses stay longer in the health care

organizations. Empowerment provides better

working conditions which facilitate future

efforts to positive outcomes. The empowered

nurses increase their condence and skills. As by

Laschinger et al, (2009) nurses' experience at

workplaces increases the quality of work.

Empowering working condition provide nurses

to accomplish their task and increase work

satisfaction in the organization. (Laschinger et al.,

2009) The ndings of this study suggested

signicant positive impact of empowerment on

organizational commitment. Empowerment

increases organizat ional commitment .

E m p o w e r e d n u r s e s f u l l l t h e i r j o b

responsibilities and provide quality care. A

study by Carman, M.B., (2011) to examine the

a s s o c i a t i o n o f e m p o w e r m e n t w i t h

organizational commitment among nurses

showed empowerment as a motivational

construct and a valuable tool for organizational

commitment. Results of the study depicted that

empowerment was highly associated with

organizational commitment.


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(2009). Context matters: The impact of unit leadership and empowerment on nurses'

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Laschinger, H. K. S., Nosko, A., Wilk, P., & Finegan, J . (2014) . Effects of unit

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nursing, 17(20), 2782-2790.



ABSTRACT

Correspondence Address IntroductionLong stay at hospital among patients produces some life threatening complications; Pressure Ulcer is one of such damaging complications. This study was assessed the knowledge of nurses regarding pressure ulcer prevention.

MethodsA cross sectional survey was conducted. A convenient sample of n=230 nurses was selected. Knowledge and practice of pressure ulcer was assessed through closed ended self-administered questionnaire.

ResultsThe ndings revealed that knowledge about the pressure ulcer among nurses was found to be not up to the mark. Only 20% participants were having good knowledge (more than 80% correct responses), 60% participants were having moderate knowledge (scored 50-75%), and 20% were having poor knowledge (scored less than 50%).

ConclusionIt is concluded that nurses have limited knowledge of effective management of pressure ulcer prevention and do not follow standard practices.

KeywordsNurses, Pressure Ulcer Prevention, Knowledge

found that prevalence of pressure ulcer is high among hospitalized patients due to bed ridden, lack of nutrition and lack of frequent positioning (Mengisitie, Berhanu, Haile, & Tesfaye) It is stated in literature that "Currently, the pressure ulcers are considered as one of the top ve most common patients harming preventable patients' safety problems (Baharestani et al., 2009). It is considered as among the most expensive and physically destructing complication among the hospitalized patients (Qaddumi & Khawaldeh, 2014). The patients with pressure ulcers feel more pain and discomfort, which further prolong their i l lness, s low down their

Among hospital staff and nurses play a very vital role in prolonging the survival of many critically ill patients. In tertiary care hospitals the critically ill patients with chronic illness and emergencies are admitted where their complexities are treated and lives are saved (Kaddourah, Abu-Shaheen, & Al-Tannir, 2016). Pressure ulcers due to prolonged hospitalization create more physical, psychological and nancial burden on patients and their families (Black et al., 2011). Pressure ulcer is dened as injury to the skin and the beneath tissue especially at the sites of bony prominence resulting from pressure, or a combination of pressure and friction both . It was

Nurses' Knowledge Regarding Pressure Ulcer Prevention Muhammad Azhar, Lecturer, Lahore School of Nursing, The University of Lahore, Pakistan

Misbah Zafar, Associate Professor, Saida Waheed FMH College of Nursing, Lahore Pakistan

Muhammad Azhar, Lecturer, Lahore School of Nursing, The University of Lahore, [email protected]

Abdul Haque Khoso, Nursing Instructor Bhittai Institute of Nursing, Nawab Shah, Pakistan

INTRODUCTION


participants were having low level of knowledge that is from 60-69% correct answers. 17.3% were having moderate knowledge (70-79%) , 8.2% participants were having high knowledge (80-89% correct responses) and remaining 53% were having very high knowledge about pressure ulcer prevention '(Dilie & Mengistu, 2015). It was found that the nurses participated in the study were having low level of knowledge that is only 63.85% correct responses'(Joseph & Clifton, 2013). From the participants 20.9% were having very low practice regarding pressure ulcer prevention, 11.7% participants were having low level of practice, 8.7% were having moderate practice level and 58.7% participants were having very high practice regarding pressure ulcer prevention (Tubaishat, Aljezawi, & Al Qadire, 2013). Results shows that 33.42% of nurses study participants always do prevention practice of pressure ulcer (Cho, Park, & Chung, 2011). Few participants that is 44% from a study sometimes perform pressure ulcer prevention practice and 24.16% of the nurses never perform the prevention practices for pressure ulcers (Moore & Cowman, 2012).

Aim of the StudyThe main aim is to assess the Knowledge level of Nurses regarding pressure ulcer prevention.

rehabilitation and increase stay at hospital. Pressure ulcers formation is a serious and multi factorial issue for health care setups (Gedamu, Hailu, & Amano, 2014). The prevalence of pressure ulcers among hospitalized patients is increasing. The prevalence rates are highest among the patients of intensive care unit. Pressure ulcers are affecting about 3 million adults in the United States leading to poor life quality, impaired body function, infection; poorer prognosis; and increased costs of care (Chou et al., 2013). There are some intrinsic factors such as diseases of peripheral vascular system, Diabetes, inability to move, nutritional deciency, urine incontinence, loss of skin sensations and old age while some extrinsic factors such as pressure, friction, lack of moisture and use of therapeutic devices increase chances of Pressure Ulcer (Gallagher et al., 2008). Nurses' knowledge and practices are also viewed as extrinsic factors for pressure ulcer formation '(Mwebaza, Katende, Groves, & Nankumbi, 2014). Poor knowledge and practice among nurses contribute to increased prevalence of pressure ulcer (Källman & Suserud, 2009). Knowledge of pressure ulcer preventive measures is the need of every health care unit especially the critical care units where the patients stay for long and their condition is very serious and they cannot move easily and stay in bed (Smith et al., 2009). The International Guidelines of Pressure Ulcer Advisory Panel classify the pressure ulcer prevention practices in to assessment of risk, care of clients' skin, recommended nutrition for prevention of pressure ulcer, clients' and family caregivers' education, loading mechanics and support surfaces (Moore & Cowman, 2012; Nuru, Zewdu, Amsalu, & Mehretie, 2015) A very good number that is 45.5% of the participants were having poor knowledge and (54.4 %) of the participants were having good knowledge in a study conducted by Miyazaki, Caliri and Santos (2010) In a study it was found that 11.7% were having very low knowledge that i s be low 60% correc t responses . 9 .7%

This research study was conducted in a public tertiary care hospital, Lahore.A cross-sectional descriptive study design was used to assess nurses' knowledge of pressure ulcer among Hospitalized patients. The population for this study consisted of all the registered nurses working at public tertiary care hospital, Lahore. The sample size for this study was determined with the help of using the formula of single population proportion.

n= (zα /2)2 × p 1−p ____________ d2

Knowledge Regarding Pressure Ulcer Prevention

MARTIAL METHODS

Table 2: Overall Knowledge

Status Number(n) Percent (%)

Poor Knowledge

Moderate Knowledge

Good Knowledge

Total

46

138

46

230

20

60

20

100


A convenient sample of n=230 nurses was recruited in the study. The information from the nurses was collected with the help of a c losed ended, self -administered structured questionnaire. The questionnaire was adapted from reviewing similar literature studies. The questionnaire consisted of questions about Demographic information, knowledge about the prevention of pressure ulcer and practice of pressure ulcer among nurses. The data was collected from May, 2016 to June, 2016.The participants' staff nurses were informed about the purpose and the end outcomes of the research. A written informed consent was provided to the participants, which ensured their willingness to participate in the study. The c o n d e n t i a l i t y a n d a n o n y m i t y o f t h e participants was guaranteed throughout this research work.

RESULTS

This section presents the outcomes of the study.Demographic ndings suggest that 53% of the study participants had age 20-30 years and 47% participants were of 30-40 years of age. 100% of the participants were females. The following table reveals that 25.22% study participants were having experience less than 5 years, about 44% were having 5-10 years' experience, and 31% were having more than 10 years of nursing experience.

Overall knowledge of Pressure Ulcer Prevention: Overall knowledge about the pressure ulcer among nurses was found to be not up to the mark. Only 20% participants were having good knowledge (scored more than 80% correct), 60% participants were having moderate knowledge (scored 50-75%), and 20% were having poor knowledge (scored less than 50% correct).

It was asked to the participants how often they do skin assessment. 34% said they always perform, 59% said they sometimes perform and 7% said they never perform skin assessment. To the answer of the use of assessment scale for pressure ulcer, 30% said they always use, 55% said sometimes and 15% said they never use. The participants were asked that how often they place pillow under patients' legs to prevent heal ulcer 43% said they always place, 51% said they sometimes place and 6% said they never place pillows. 26% of the participants shared that they always advise care givers to use cream on patients' skin, and 61% responded sometimes and 13% said they never advice.


DISCUSSION

In this study knowledge and practice of nurses was assessed among nurses. Moderate level of knowledge was found among the majority of nurses that is only 20% participants were having good knowledge (more than 80%), 60% participants were having moderate knowledge (scored 50-75%), and 20% were having poor knowledge (scored less than 50%). Few studies were found with similar ndings of nurses knowledge about pressure ulcer prevention. According to Nuru et al., (2015),

47 VOL 01 ISSUE 01 JAN-MAR 2017

45.5% of the participants were having poor knowledge and (54.4 %) of the participants were having good knowledge. Another cross sectional survey found that 17.3% were having moderate knowledge (70-79%) , 8.2% participants were having high knowledge (80-89% correct responses) and remaining 53% were having very high knowledge about pressure ulcer prevention (Dilie & Mengistu, 2015). According to another research study possible score of the Pressure Ulcer prevention Knowledge ranges from 0 to 47. The mean score of correct answers for all participants was (71.5 %). Only (73.3 %) of the study participant achieved a mean score of more than 70% (Kaddourah, et al ., 2016). Few main practices related interventions were found very low among nurses regarding pressure ulcer. Assessment of common contributing factors was studied and 59% said sometimes assess while 14% said they never assess for them. Skin assessment practice was assessed, 59% said they sometimes perform and 7% said they never perform skin assessment. It was also found that how often they use risk assessment scale for pressure ulcer 30% said they always use, 55% said sometimes and 15% said they never use. It was also studied that how often they document the data related to pressure ulcer. 44% said they sometimes document and 30% said they never document. All these results indicate poor practice of pressure ulcer prevention. Previous studies are performed and found very poor practices as according literature 20.9% were having very low practice regarding pressure ulcer prevention, 11.7% participants were having low level of practice, 8.7% were having moderate practice level and 58.7% participants were having very high practice regarding pressure ulcer prevention. Another study found that 33.42% of nurses study participants always do prevention practice of pressure ulcer, 44.42% participants sometimes perform pressure ulcer prevention practice and 24.16% of the nurses never perform the prevention practices for pressure ulcer (Werku, 2015).

The time was very short to complete this study. Small sample was studied which was not a true representative for the larger population so the study cannot be generalized.

Conclusion

In conclusion it was found from this study that nurses were having very poor knowledge about the pressure ulcer prevention. They scored very low on a knowledge based questionnaire about the pressure ulcers. Practices of pressure ulcer were also not very high among the nurses.

Acknowledgement

Special thanks to the HOD of the nurses of different departments and to the participants nurses who willingly participated in the study.


Dilie, A., & Mengistu, D. (2015). Assessment of

Nurses' Knowledge, Attitude, and

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ABSTRACT

Correspondence Address IntroductionStress is sometimes productive but in some situations the situation becomes so stressful that it can affect the nurses as well their service provided to patients. This stress can be managed with modifying the way of behavior in such situations or using the coping behavior.

MethodsThis was an analytical cross sectional study in which the convenient sampling was used. The data was taken from the nurses working in Services hospital and the sample size was 250 calculated through slovin's formula .

ResultsSignicant positive relationship was found between the workplace stressors and coping behaviors among nurses.

ConclusionPositive relationship was found between workplace stressors and coping behaviors among nurses. The stress level among nurses is high enough to be taken into account. Nurse should be taught to use the coping behaviors to handle their stress.

physical and mental health . The human body manages the stress by activating the ght and ight system of the body. But the stress that is prolonged can make your mental and physical s y s t e m d e c r e a s e d ( B r u c e , 2 0 1 3 ) .The major stressors faced by nurses in the work place are workload, conict with supervisor or doctor, absence of the doctor in the emergency situation, lack of support by the peers, being s e x u a l l y h a r a s s e d , s h i f t w o r k b y t h e organization, dealing with a dying patient and not being prepared to answer the questions of the

Nurses are the health care individuals who have high responsibilities for the care of patients but have restricted resources. Such imbalances sometimes become the stress source for the nurses. When the nurses are unable to manage the stressful situation using their own abilities they utilize some mechanisms called the coping strategies to overcome the stressor (Khamisa et al., 2015).According to the survey of American Psychological Association (2016) the job related stress is very important to maintain your

Kinza Mahboob Student,Lahore School of Nursing, The University of LahoreLahore, Pakistan

[email protected]

Keywords stressors, coping behavior, nurses, work place, job, management

Kinza Mahboob, Student, Lahore School of Nursing, The University of Lahore, Lahore, Pakistan

Muhammad Afzal, Associate Professor, Lahore School of Nursing, The University of Lahore Lahore, Pakistan

Sana Sehar, Assistant Professor, Lahore School of Nursing, The University of Lahore, Lahore, Pakistan

Work place stressors and the coping behaviors among nurses in Lahore, Pakistan

INTRODUCTION

mailto:[email protected]


patient (Dagget et al., 2016).The coping behaviors which are employed by the nurses most of the stressful situations are avoiding the situation, making plans to solve the problem, sleeping and being having a positive attitude towards stress (Khater, 2014). In a study about the stress among health care professionals it was investigated that nurses are at the edge because they nd many situations which are stressful for them causes of stress among nurses are handling of a patient alone in the ward (83.6%), no break for relaxation of mind during the duty hours (82.2%), insufcient staff for providing health care (91.8%) and the lack of the supervisory staff to motivate the nurses for their work (98.6%) (Godwin et al., 2016).A study was conducted in Malaysia on stress among staff nurses and the coping behavior among nurses the study included the 185 nurses who reported the stress they experience in the hospital and the behaviors they use to cope with stress (38%) seek social support, (45%) control mechanism, (30%) manage the symptoms and (19%) try to escape (Beh & Loo, 2012).A study conducted at Ghana on stress and the coping mechanisms to manage stress among staff nurses highlighted the behaviors of managing stress and showed that (60%) go on a break, (51.6%) use meditation (64.1%) exercise, (74.3%) use the technique of relaxation (4%) eat excessively (50%) accept the circumstances, (61%) laugh most of the time. The nurses shared that without using the coping mechanisms it is very hard to perform duty with competency and to prevent adverse effects of stress on their health (Godwin et al., 2016).Results of a research carried out in Karachi showed that 87.4% of the nurses were stressful due to their job and 32.2% were suffering from severe stress. The study has not revealed any coping method that nurses can utilize or adopt to manage their stress (Badil, 2016).The research at Ethiopia suggest that the high level of stress in the working environment effect the life of nurses as well of the patients it also causes the poor health care delivery to the

patients and increases the cost of health care. The research explored the fact that 41% nurses at public hospital of Addis Ababa were not satised with their job due to severe stress in hospital and 22% wanted to leave the hospital (Salilih, 2014).Nurses face stress when there is lack of doctor and many of the work that should be done by the doctor are handed over to the nurses. The conicting behave of the physician, supervisor and peers cause stress in the nurses (Akangbe, 2015). There is a signicant positive relationship of workload with the use of confronting coping, problem solving and relying on others to manage the stressful situations at work place (Makie, 2006).Nurses have stress because they are not allowed to practice as autonomous. The nurses face stress when they are not involved in the teamwork. Nurses feel stress when they feel loss of control such as nurses schedule is not involving all the nurses (Ndawula, 2016). By talking to fellows who are working in a team and expecting their help can reduce the stress, having condence in yourself and implementing learning from the past experience and avoiding the conicting person can help in the management of stress (Ndawula, 2016). A research was conducted in Peshawar and it was found that most of the nurses 65% were having difculty in performing their duty due to the uncooperative behave of supervisor/matron and head nurses. 52% nurses reported frequent occurrence of stress due to supervisor, 32% reported extreme occurrence and 16% as occasional occurrence of stress (Khan et al., 2015). Seeing the situation objectively and avoiding the situation helps in coping with the stress due to lack of support (Alsaqri, 2017).A study conducted in Greece has revealed that the cause of uncertainty of the nurses is the inappropriate behavior of the physician of not being present and showing irresponsibility. The nurses may have stress due to uncertainty because they have lack of condence about their skills (Saras,2016). According to the study of

Work place stressors and the coping behaviors


Etim et al., (2015) the uncertainty regarding patient treatment can be coped up by having condence, planful problem solving and showing condence in each task. According to Akuroma (2016) the care of the death or dying patients is a big challenge for the nurses. This care needs the patient to be given complete rest and comfortable proceeding towards death. The research conducted in South Africa has highlighted that nurses use to seek the help of others, remain optimistic, use plan ful problem solving, praying to the God and accepting their challenging responsibility to cope with stress (Batak, 2013).The relationship of the dissatisfaction with organizational decisions and effect of shift work on family life was analyzed (p<0.05) (Moradi et al., 2014). According to the research nurses who work in rotating shifts experience occupational stress four times than those who were working on xed shifts of (Abajobir, 2014).A study conducted in New Work showed that the participants told that the organizational support as well the family support helps is very important in coping with the stress of organizational decisions. The study results also revealed that exercising and having short breaks in the duty time to rest in the staff room decreases the stress levels of the nurses (Vitale, 2015). According to Maike (2006) there is positive relationship between stress from inadequat preparation and coping behaviors seeking for the support of others and using the problem solving method.A study conducted in Nigeria showed that the nurses are sexually harassed by the physician, patient or the male colleagues by the activities like shaking hand (75.9%), sexual gestures (62.1%) and staring in a sexual manner (98%). Nurses handle with these stressors by adopting the coping behaviors of being aggressive and verbally dealing with the person (34.5%), trying to avoid the person (84.5%), reading something to confront with the sorrow of being abused (47.9) and considering it as their fate and praying for heavenly help (Arulogun, 2013). The study

conducted in Finland the employment of coping behaviors is signicant in the reduction of stress level (Liliia, 2016).Among health care professionals majority (78.3%) of the respondents reported that they try to manage to take a break and rest to manage the stressful s i tuation while some (21.7%) participants said that they wait for the next staff to come and take the over (Etim et al., 2015).

Aims of the Study The aim of this study was to investigate the relationship between stressors and coping behaviors among nurses.


MARTIAL & METHODS

The research was conducted in Services hospital. As the objective of the study was to identify the most common stressors among nurses, to investigate which coping behaviors are mostly used by nurses and to invest igate the relationship between the stressors and coping behaviors analytical quantitative cross sectional study design was used. The target populations were staff nurses. Convenient sampling method was used.The Expanded Nursing Stress Scale which was developed by Gray-Toft and Anderson in 1981 was adapted to assess the stressors. The reliability of the scale was 0.96.Coping Behavior Inventory was used to assess the coping methods used among nurses. The tool was developed by Sheu et al. (2002). The reliability of the instrument is 0.76 to 0.80. A formal written letter of permission to conduct the research was taken from the organization. Permission to collect data from the nurses was taken from the Nursing Superintendent of Services hospital. After that the consent was taken from the staff nurses willing to participate in study. Data entry was completed by the primary investigator at SPSS version 21. The data was shown in table form. The central tendency and dispersion was measured of the variables. Pearson correlation analysis was used to investigate the relationship between the

Table 2: Common stressors among nurses

Absence of physician in emergencysituation

(94%)

(90.8%)Centralization; in decision making Shortage of time

(87.6%)Lack of opportunity to share

Stressors Always Stressful


RESULTS

Prole of the RespondentsRespondents were taken from services hospital which is a Government institute. Initially the descriptive statistics were displayed followed by the inferential statistics


Table 1: Demographic Characteristics

Variable Category Frequency Percentage

GenderMale 7 2.8

Female 243 97.2

Nationality Pakistani 250 100

Age

20-25 years 52 20.8

92 36.8

31-35 years 27 10.8

21 8.4

41-45 years 14 5.6

31 12.4

51-55 years

13 5.2

ReligionIslam

26-30 years

224 89.6

christen

36-40 years

26 10.4

46-50 years

Marital Status

Un Married 154 61.6

Married 96 38.4

Experience of work

1-5 years 117 46.8

6-10 years 53 21.2

11-15 years 62 24.8Duty hours

6 hours 204 81.6

12 hours 46 18.4

s t r e s s o r s a n d t h e c o p i n g b e h a v i o r s .Participants were informed about the aim of the study. The personal information like name, phone number and address was in the access of the primary researcher and was not mentioned in research. All the nurses had the equal right to participate or withdraw. The participants were given information about the possible benets and risks of the research, and were free to sign the consent. No portion of the truth was covered from the participants about the study.

Disability Yes 3 1.2

Head Nurse

No 247 98.8

No. Of dependents

0-2 133 53.2 3-5 45 18.0

6-8 71 28.4 9-11 1 .4

Designation at present

Staff Nurse 227 90.8

22 8.8

Table no. 1 is showing the demographic data of the participants. In participants 2.8% were male and 97.2% were female. The nationality of all the participants was Pakistani. 20.8% nurses were between the age group 20-25 years. 36.8% nurses were from the age group 26-30 years. 10.8% nurses were of the age group 31-35 years. 8.4% nurses between the age of 36-40 years. 5.6% nurses were from the age group 41-45 years. 12.4% participants were from the age group 46-50 years. And only 5.2% nurses were from the age group of 51-55 years. The religion of 89.6% nurses was Islam. 10.4% nurses were christen. 61.6% nurses were unmarried and 38.4% nurses were married. 46.8% nurses had the experience from 1 to 5 years. 21.2% nurses were having the experience of 6-10 years. 24.8% nurses had experience of 11-15 years. 81.6% participants were performing duty of 6 hours. 18.4% nurses were during job 12 hourly. 98.8% nurses had no disability. 1.2% nurses were having some disability. 53.2% nurses had 0-2 dependents. 18.0% nurses had 3-5 number of dependents. 28.4% had 6-8 and .4% had 9-11 number of dependents. 90.8% participants were staff nurses and 8.8% were head nurses.

Table 3: Coping Behaviors most utilized for

different stressors among nurses

Workload

To adopt different strategies to solve problems

(84.4%)

Conict To have condence in overcoming difculties

(76.4%)

Lack of support

(88.7%)

Uncertainty regarding patient treatment

To employ past experience to solve problems

Having condence in performing task as well as senior nurses was utilized by majority of the nurses

(76.4%)

To expect miracles so one does not have to face difculties

(78%)Dealing with death and dying patient Organizational decisions

optimistic and positive attitude in dealing with everything in life

(75.2%)

Stressor Most common Coping Behavior

%of use


experiences and feelings with other personnel in the unit

(85.6%)

Lack of opportunity to talk openly with other unit personnel about problems in the unit.

(85.6%)

Table No. 2 is showing the stressors which were reported as always stressors by more than of the nurses. Absence of physician in emergency situation (94%), Centralization; in decision making (90.8%), Shortage of time (87.6%), Unable to talk about ward problems (85.6%) and Unable to share feeling with someone in ward (85.6%).


Inadequate preparation

To expect others to solve the problem

(81.6%)

Sexual Harassment

To quarrel with others and lose temper

(84.4%)

Table No. 3 is showing the coping behaviors which were mostly utilized by the nurses for the relevant stressor. The most used coping behavior

Workload 0.009 0.890

Workload Setting up Objectives 0.738

WorkloadPlanning and Setting Priorities

0.607

Stressor Coping Behavior Value of r p value

-0.033

-0.021

Problem solving Strategies

Table 4: Relationship between stressors

and Coping behaviors

for workload was to adopt different strategies to solve problems (84.4%). The coping behavior that was Always Used by most of the nurses was To have condence in overcoming difculties (76.4%). Having condence performing task as seniors was utilized by majority of the nurses (88.7%) for stress from Lack of support. Majority (76.4%) of the nurses reported that they use previous experience to overcome the stress of uncertainty regarding patient treatment. Expecting miracles (78%) was reported as mostly used for the stress of death and dying. To keep an optimistic attitude to cope with stress by organizational decisions (75.2%). Expecting others help was reported as always utilized by a large number of participants (81.6%) to cope with stress of inadequate preparation. Always used response reported by majority (84.4%) of the nurses was Quarreling and losing temper to cope with the stress of sexual harassment.

Mean of Stress scale 1.000 0.000

Mean of Coping Behavior 1 0.000

Variable Pearson

Correlation p value

Table no. 4 is showing that there is positive signicant relationship between stressors and Coping behaviors.

Table 5: Relationship between items of

stressors and coping behaviors


WorkloadFinding the meaning of event

0.656

WorkloadEmploying Past experience

WorkloadHaving Condence to overcome difculties

0.139 0.028

Workload Avoiding Difculties 0.145 0.022

WorkloadExpecting others to solve problems

0.197 0.002

ConictHaving Condence to overcome difculties

0.012 0.850

ConictEmploying Past experience

0.254 0.000

Conict See things objectively 0.233 0.000

Conict Avoiding supervisor. 0.391 0.000

Lack of Support

See things objectively 0.000

Having Condenceto perform like seniors

0.161 0.011

Crying & Feeling Moody 0.064 0.312

Expecting others to solve problems

0.154

Planning and Setting Priorities

0.129 0.042

Avoiding supervisor 0.016

Having Condence to overcome difculties

0.235 0.000

Lack of Support

Lack of Support

Lack of Support

Lack of Support

Lack of Support

Uncertainty

0.152

-0.154

-0.239

0.502 -0.043

-0.028



0.388 0.000

Employing Past experience

0.255 0.000

regarding patient treatmentUncertainty

regarding patient treatmentUncertainty

The Table no 5 is showing the relation of coping behavior with different stressors. There was small signicant correlation of workload.The Table no 5 is showing the relation of coping behavior with different stressors. There was small signicant correlation of workload as a stressor with the utilization of coping behaviors (a) Having condence to overcome difculties (r=0.139, p=0.028) (b) Avoiding difculties


0.144 0.023


0.138 0.030

Dealing with dyingpatient

Dealing with dying patient

regarding patient treatment


Organizational decisions

InadequatePreparation

Sexual Harassment




Sexual Harassment

Sexual Harassment


Being Optimistic in life

Relaxing via TV & exercise

Saving time to sleep for good health

Feasting and sleeping

Quarrelling & Losing temper

Expecting Miracles to happen

Avoiding Difculties


InadequatePreparation



Expecting Miracles to happen

-0.098

-0.076

-0.194

-0.350

0.150

-0.203

-0.014

0.009

-0.081

0.009

-0.132

0.121

0.231

0.002

0.000

0.018

0.001

0.831

0.883

0.199

0.888

0.037


(r=0.145, p=0.042) and (c) expecting others to solve the problem (r= 0.197, p=0.002) . No signicant correlation was found between workload and the utilization of coping behaviors (a) Problem solving strategies (r=0.009 p=0.890) (b) setting up objectives (r=-0.021, p=0.738) (c) Planning and Setting Priorities (r= -0.033, p=0.607) (d) Finding the meaning of event (r= -0.028, p= 0.656) and (e) Employing past experience to solve problems (r=-0.043, p=0.502). Small Signicant correlation was found between conict and utilization of the following coping behaviors (a) Employing past experience (r=0.254 , p<0.01) (b) Seeing things objectively (r=0.233, p<0.01) and (c) Avoiding supervisor (r=0.391, p=0.00) . No signicant correlation was found between conict and coping behavior Having condence to overcome difculties (r= 0.012, p=0.850).Small signicant correlation was found between Lack of support and the following coping behaviors (a) Having Condence to perform like seniors supervisor (r=0.161, p=0.011) (b) Dealing with dying pt. (r= 0.129, p=0.042) and (c) Avoiding supervisor (r=0.152, p=0.016).Small negative signicant correlation was found between the Lack of support and seeing things objectively (r= -0.239, p<0.01)No signicant correlation was found between lack of support and the coping behavior Crying and Feeling moody (r= 0.064, p=0.312).Signicant small correlation was found between Uncertainty regarding patient treatment and coping behaviors (a) Having Condence to overcome difculties (r=0.235, p<0.01) (b) Planning and Setting Priorities (r=0.388 p<0.01) (c) Employing past experience (r=0.255, p<0.01).There was a signicant weak correlation, between Dealing with dying pt. and utilization of the following coping behaviors (r=0.144 p=0.023) (a) Expecting others to solve problems ( b ) H a v i n g C o n d e n c e t o o v e r c o m e difculties(r=0.138, p=0.030).No signicant correlation was found between Dealing with dying pt. and the coping behaviors (a) Expecting Miracles to happen (r=-0.098,


p=0.121) (b) Dealing with dying pt(r=-0.076, p=0.231).Signicant weak correlation is found between Organizational decisions and coping behavior Saving time to sleep for good health (r=0.150, p=0.018). Negative and weak signicant correlation was found between Organizational decisions and coping behaviors (a) Relaxing via TV & exercise (r= -0.350, p<0.01) (b) Being Optimistic in life (r= 0.0194, p<0.01) and (c) Feasting and sleeping (r= -0.203, p<0.01).No correlation was found between Inadequate preparation and coping behaviors (a) Having Condence to overcome difculties (r=-0.014, p=0.831) and (b) Expecting others to solve problems (r=0.009, p=0.883). No correlation was found between Sexual Harassment and coping behaviors (a ) Quarrelling & Losing temper (r= -0.081, p=0.199) (b) Expecting Miracles to happen (0.009, p=0.888). Signicant negative and small relationship was found between Sexual Harassment and coping behavior Avoiding Difculties (r= -0.132, p=0.037).

DISCUSSION

The study shows that there is positive signicant relationship between the stressors and coping behavior among nurses which indicates that the nurses have the knowledge to adopt the coping behavior to overcome their stress. To overcome the stress causing items in the workplace the nurses use coping behaviors to keep their job going on (Ribeiro, 2015). The study conducted in Finland has indicated that e m p l o y m e n t o f


coping behaviors are signicant in the reduction of stress level among nurses (Liliia, 2016).The stressors that were always stressful for most of the nurses were uncertainty regarding patient treatment followed by the item physician not being present in the medical emergency. In line with this a study conducted in Greece has revealed that the cause of stress in nurses is the inappropriate behavior of the physician of not being present and showing irresponsible behave on duty. Organizational decisions followed by no participation in decision making were also reported by most of the nurses. The result is similar to the research conducted in Tehran that showed that there is signicant relationship of the dissatisfaction with organizational decisions (Moradi et al., 2014). The nurses are not independent in the treatment procedure of patient. The patient is not the responsibility of a single person. But it is the task of all the health care team members to work in coordination. . Emergency situation needs to be handled by the nurse as well the physician. The results showed that workload had no signicant relation with coping behaviors problem solving strategies, setting up objectives, planning and setting priorities, Finding the meaning of event and employing past experience. In contradiction to this the study conducted in Saudi Arabia the most common coping behaviors used by the students were making plans, listing priorities of the problems, using problem solving method to nd solution and using the past experience in solving the problem among nurses. The workload has weak signicant relationship with having condence to overcome difculties,avoiding difculties, Expecting others to solve problems. The studies have shownthere is a signicant relationship of workload with the use of confronting coping, relying on others , and to avoid difculties to manage the stressful situations at work place (Makie, 2006). First of all the confronting coping behavior shows that nurses know their duty and in increased workload they face it. Taking assistance from others shows a helping and


friendly atmosphere of the organization. There is no signicant relationship between conict and coping behavior to have condence to overcome difculties. The result is opposite to the result of the study conducted in Uganda showed that , having condence in yourself helps in overcoming with the stress due to conict with the doctors and nurses in ward (Ndawula, 2016). The lack of condence in overcoming difculties may be due to the condence in a conicting situation may increase the conict. The conict has weak signicant relation with coping behaviors employing past experience, see things objectively, avoiding supervisor the results are just similar to the results of the study conducted in Uganda that implementing learning from the past experience and avoiding the conict ing person can help in the management of stress (Ndawula, 2016). The consistent results show that nurses have enough knowledge and sense to use their prior knowledge and plan according to their experience to release the stress from conict. They try to avoid the person that is conicting to avoid any such happening. The study results show weak signicant but negative relationship between lack of support and seeing things objectively while according to Alsaqri (2017), seeing the situation objectively and avoiding the situation helps in coping with the stress of Lack of support. Lack of support has weak signicant relation with having condence to perform like seniors, planning and setting priorities, avoiding supervisor in current research. Another study conducted in Saudi Arabia has also concluded that avoiding the supervisor's behave and considering it temporary, seeking or the help of others, accepting the responsibility and doing it with condence, avoiding the situation and avoiding the negative feeling along with being optimistic to overcome their stress (Makie, 2006). This indicates that nurses are condent in performing their job and are able to set their priorities. The result is also showing that when


they are unable to get the support of supervisor they consider it that have to perform their task alone and they cannot complain so they try to avoid the supervisor. There is no signicant relationship between lack of support and coping behaviors Expecting others to solve problems and Crying & Feeling Moody. The result may relate to the self respect of the nurses. When they don't get support they try to avoid and never try to expect from the unsupportive person this may decrease their self esteem. The uncertainty regarding patient treatment has weak signicant relationship with the coping behaviors Employing Past experience, planning and setting Priorities, having Condence to overcome difculties. The result studies are consistent with the results of other studies. According to the study of Etim et al., (2015) the uncertainty regarding patient treatment can be coped up by having condence, planful problem solving and showing condence in each task. The nurses cannot become successful without getting knowledge from their experience. The study shows that nurses are taking advantage from their experience by making their mind certain about condition and treatment of a patient. Performing every task with condence and setting priorities helps the nurse to overcome the condition of uncertainty. The result has shown that dealing with death and dying has weak signicant relationship with Expecting others to solve problems and Having Condence to overcome difculties and this result is consistent with the result of other studies as the study conducted in south Africa shows that the relying on others and having condence are most used coping behaviors among nurses. The result is indicating high condence and practicality among nurses. The result also shows a good bonding among nurses that in such difcult situation they rely on one another. The stress of death and dying has no signicant relationship with Planning and Setting Priorities and Expecting Miracles to happen in current study which is contradicted according to the study of the Batak (2013), which states that


accepting responsibility, planful problem solving and Praying to God are used to cope with stress. The nurses in their emotional stressful situation donot get time to plan and set priorities to overcome the situation. In such time God's help should be expected. The nurses should be given education about the role of spiritual belief and such happening. They such be trained to pray for such patient and believe on God and also advice the attendants of the patient. The study results indicate a weak and negative relation between organizational stressors and Being Optimistic in life, Relaxing via TV & exercise, Feasting and sleeping and showed positive signicant relation with coping behavior Saving time to sleep for good health. Vitale (2015) in his study on stress and coping behavior has stated that nurses cope with stress of organizational decisions by getting social support, exercising and having short breaks in the duty time to rest in the staff room. The result indicate that nurses take rest and sleep to cope with the stress. This is might due to that the job of nurses is very tiring. There is no signicant relationship between Inadequate Preparation and any coping behavior which is opposite to many other studies. The results may suggest that nurses s h o u l d e n h a n c e t h e i r k n o w l e d g e a n d organization should give stress to build a friendly environment among nurses at senior or junior level so that the nurses may take assistance and knowledge from their colleagues and with this condence they may cope with this stress. Sexual harassment has weak and negative relationship with Avoiding Difculties and has no relationship with Expecting Miracles to happen and Quarrelling & Losing temper. Other studies have given many coping behaviors in relation to the sexual harassment. According to a study conducted in Nigeria nurses cope with sexual harassment by verbally dealing with the person, trying to avoid the person, reading something and praying for heavenly help (Arulogun, 2013). The current study shows that majority of the nurses do not utilize coping

Alsaqri, S. H. (2017). Stressors and Coping Strategies of the Saudi Nursing Students in the Clinical Training: A Cross-Sectional Study. EducationResearch International, 2017.

Amarneh, B. H. (2017). Social Support Behaviors and Work Stressors among Nurses: A Comparative Study between Teaching and Non-Teaching Hospitals. Behavioral Sciences, 7(1), 5.

Arulogun, O. S., Omotosho, I. K., & Titiloye, M. A. (2013). Experience of sexual harassment and coping strategies among students of the school of nursing of a tertiary hospital in Southwest Nigeria. International Journal of Nursing and Midwifery, 5(4), 70-75.

Batak, T., Gvozdenović, L., Bokan, D., & Bokan, D. (2013). The impact of nurses' shift work on the fatigue level. South Eastern Europe Health Science Journal, 3(2), 120-7.

Beh, L.-S. and L.-H. Loo (2012). "Job stress and

coping mechanisms among nursing staff in public health services." International Journal of Academic Research in Business and Social Sciences 2(7): 131.

Bruce, J. (2013). "The Cost of Stress in Your Organization & What You Should Do About It." Online: mequilibrium.

Dagget, T., Molla, A., & Belachew, T. (2016). Job related stress among nurses working in Jimma Zone public hospitals, South West


behavior which may be due to the severe emotional disturbance and shock. The training should be provided to the nurses to use coping behavior and organization may organize teaching sessions on use of coping behaviors of specically sexual harassment. The study conducted is cross sectional study due to time limitation. The study is explaining the stress among nurses working in the public hospital the results may differ in private hospital. The study is conducted on the nurses of entire hospital using convenient sampling which has disadvantage of less generalizability.

ConclusionThe important nding of the study was that the frequency of reported stress is enough to be taken into account. There is strong positive relation between workplace stressors and coping behaviors used among registered nurses. It is notable that no positive signicant relationship was found of inadequate preparation and sexual harassment and any coping behavior.

Acknowledgement I would like to thank all of my teacher specially supervisors. I am also thankful to the University of Lahore for allowing me to conduct this research. I am grateful to my friends and my family and I would like to give a special thank to my father Mirza Mahboob Alam and Mr. Tasawar Hussain an old teacher of mine for encouraging me and supporting me.


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ABSTRACT

Correspondence Address IntroductionThis study guesstimate individual's interactive effect of workplace bullying and turn over intention among nursing. The study conducted in a private hospital in Lahore, which determined effect on nurses' work place bullying on turnover intention. Purpose of this study was to nd out the effect on nurses workplace bullying on turn over intention.

MethodsThis was an observational, cross-case study design. Target population was staff nurses and sample size was 180. Staff nurses of private hospital were included who fulll the inclusion criteria and others was excluded. Data was collected by using convenient sampling technique. The questionnaires was used to measure the possible respondents awareness, opinions and to various experiences concerning bullying and turnover intention.

ResultsThis study result revealed that there is a signicant relationship between work place bullying on turnovers intention of nurses. Workplace bullying behavior and turnover intention has signicant positive relationship. Furthermore, the individuals who experience low level of workplace bullying behavior shows better work other than that experienced bullying behavior.

ConclusionsBulling is a dislike behavior at work place which create a psychological disturbance for the nurses and negative image of organization environment. Bulling is an important factor which causes the individuals to leave the organization.

Keywords Workplace bullying, Turnover Intention

Effects of Workplace Bullying on Turn over Intention among Nurses

Muhammad Hussain, Assistant Professor, Lahore School of Nursing, The University of Lahore, Pakistan

Muhammad Yousif, Co-ordinator, Academics, Indus College of Nursing & Midwifery, Karachi, Pakistan

Muhammad Sabir, Lecturer, Lahore School of Nursing, The University of Lahore, Pakistan

[email protected]

Muhammad Hussain, Assistant Professor, Lahore School of Nursing, The University of Lahore, Pakistan

Bulling is not a health practice in any organization, and it. is unfavorable for employees’ assurance, job satisfaction, absence, and turnover The workplace (Obicci, 2015).

bullying represents a very serious problem in m a n y c o u n t r i e s b e c a u s e o f t h e

considerable harmful impact to employees, organizations and to whole society (Tambur, 2015).

Work place bullying is a situation in which worker faces, a disgrace in a work place environment. The social separation can be occurring due to work place bullying. The

INTRODUCTION


concept is very old. A study show that The bulling at workplace have the positive inuence on the intention to quit the job, and which exposes the common effect of bullying even though the less rigorous nature of the bullying are attached with sufferers intention to turnover or leave a workplace (Rasool, Arzu, Hasan, Ra, & Kashif, 2013).In one study result revealed that the individuals bullying has the direct and the indirect consequence on nurses turnover intentions which have stress throughout the job (Malik, Sattar, Shahzad, & Faiz, (2017). On the whole organization faces loses due to bullying at work place. This negative behavior is a threat for workers, their job, organizational commitment and turn over intention. Most of the nurses leave their organization due to bullying at work place environment which is the huge burden for organization. Many studies suggest that effect of bullying in nursing professional workplace victim but also health care delivery system as well as quality of care and its effects on organization nances (Hogh, Hoel & Carneiro, 2011). Shortage of nurses is increases all over the world. Organizational factors such as leadership, development opportunities, and pay level are among the most connected to the nurses' turnover intention. Turnover intention is one of the major issues for any organizations. The more exposure of bullying in workplace area in various organizations to increase the turnover level because bullying may show impact on cost effectiveness (Hogh, Hoel & Carneiro, 2011). It has been observed that Bullying reduce organizational routine or performance by the effect of employee performance output through both the absenteeism and the worker turnover from the organization (Hogh, Hoel & Carneiro, 2 0 1 1 ) . A m o n g n u r s e s b u l l y i n g i s t h e internationally badly-behaved. There is limited homework which examined the factors in work environments of nursing that could progress exposure to the bullying (Blackstock, Harlos, Macleod & Hardy, 2015).Operational denition: Work place bullying:It is dened as an unnecessary, violent behavior

that involved a real or alleged power imbalance. Bullying consist an actions such as creating threats, propagating rumors, violate someone in physical or verbal way, and somebody separated from the group.

Workplace bullying is a situation in which person feel disgrace at working environment of an unlimited time and no possibility of defense. It effects on nurse psychology and her emotions ultimately she decide to leave workplace (Tuckett, Parker, Eley,& Hegney, 2009). The person experiences to think bully or stressed. As well as it has been explored whether workplace bullying decrease work output and what kind of impact it has on work-related health outcomes Berry, Gillespie, Gates & Schafer, 2012;. Tuckett, Parker, Eley, & Hegney, 2009). Previous studies on nurses' turnover intention have relationship between nurses' psychosocial work environment and organizational societyGalletta, Portoghese, & Battistelli, 2011); Kuvaas, 2006). Managers and their rm hierarchical organizational structure in hospitals promote workplace bullying. A recent study conducted on work place bullying on turn over intention shows a signicant relationship (Kuvaas, 2006). Nurses signicantly have low level of satisfaction with job and higher level of anxiety, depression and leaving the organization due to this work place bullying. They were feeling disgrace in the organizational environment. Support at work from the managers was able to protect nurses from these bad effects of bullying(Kuvaas, 2006). Turnover intention gives the probability of workers to leave their work as well as institutional willpower(Kuvaas, 2006). As turnover increases, level of absences too increased. The turnover causes many environmental issues, in order that, the directors may require necessary steps to pass up the possibility of turnovers (Bohdanowicz, Zientara & Novotna, 2011). It is observed in the literature that different studies have used the terms of bullying and mobbing interchangeably. The various studies discussed about the relation between bullying at workplace and turnover (Hogh, Hoel & Carneiro, 2011). Bullying at

Workplace Bullying an Turn over Intention

RESULTS


workplace is a term related with constant contact to undesirable and deleterious actions from one or more persons against a person or a group, where they created an inequality in authority (Hogh, Hoel & Carneiro, 2011). The bullying at workplace has an unfavorable environment for the success, quality work and turnover. Ratio must measure In the literature different terms including insult, verbal abuse, excessive ridicule and violence were dened clearly (Houshmand, O'Reilly, Robinson, & Wolff, 2012; Owoyemi, 2011). Scientists have made the efforts to know the environment of harassment. Agreement of the harassment commonly arise an effect on inequality. Casualty of harmful performance has not an identical situation as the people don't able to defend (Ilongo, 2013).

Aim of The StudyThe aim of this study was to, explore the association between bullying behavior at workplace and turnover intention of nurses.

The research was conducted in two private hospitals. RESEARCH DESIGN, a descriptive cross-sectional study design was used. As the objective of the study was to. Assess the association between work place bulling and turnover intention. The target populations were 500 staff nursesRespondents' selection was done by convenient sampling technique.A questionnaire was designed for this study to gather data to answer the research questions. The data was collected from April, 2015 to June, 2015.Ethical clearance obtained from the ethical committee of the Lahore school of nursing. Administrative permission obtained from the concerned authorities to conduct the study from selected hospital. A written consent was obtained from the samples and condentiality was assured, for assessing the effect of workplace bulling on turnover intention, and Participants were informed about the aim of the study.

This section presents the outcomes of the study which include two portions of analysis. First is demographic analysis. It gives details of demographic questions about participant gender, age, education, and stay in organization and sampled organization, second portion is descriptive analysis, and it is used for fourteen questions about Workplace Bullying and four questions about Turnover Intention.According to the table 1. Respondents were taken from private institutions. Subjects of both gender participated in the study, male were 12.8 % and female 87.2 %. Distribution of Age group was as, that 24.4% respondents belong to 18-25 year and 75.6% of respondents belong to 26-35 year groups. Education of subjects was as, that 93.3 % respondents belong to nursing diploma and 6.7% respondents belong to other education. And Stay in Organization (experience) of respondents was, that 13.3% have experience less than 1 year and 86.7% have 1-5 year experience. According to the organization, 70.6% respondents be long to FMH and 29 .4 respondents belong to doctors' hospital.


MARTIAL & METHODS

Demographic Data Frequency Percent

GenderMale

FemaleTotal

Distribution of Age

18-25 Year26-35 Year

Total

QualicationNursing diploma

OtherTotal

Stay in Organization

Less than 1 year1-5year

Total

23157180

44136

100.0

16812180

24156180

12.887.2100.0

24.475.6100.0

93.36.7

100.0

13.386.7100.0


Organizations FMH

Doctors hospitalTotal

12753180

70.629.4

100.0

Descriptive Analysis,According to the Research Question 1. The law of victimization is satised and familiar responses were (1.7) % strongly disagree (52.2) % disagree


(7.2) % neutral (13.8) % agree (18.3) % strongly agree. Question 2. Hospital where you work their policies and guidelines fulll the concern of workplace responses were (.6) % strongly disagree (48.9) % neutral (15) % agree (20.0) % strongly agree (22.2) %. Question 3 the hospital you work for anyone is educated in questions for workplace bullying were (46.7) % strongly disagree (10.0) % disagree (18.3) % neutral (25.0) % agree (15.0) % strongly agree. Question 4 during the employment at some point staff should inform that workplace bullying is not satisfactory responses were (1.1)% strongly disagree (3.3)% disagree (7.8)% neutral (56.7)% agree (31.1)% strongly agree. Question 5 your organization has contributed with enough information about workplace bullying (2.2) % strongly disagree (50.6)% disagree (8.3)% neutral (18.9)% agree (20.0)% strongly disagree. Question 6 you perceive that work related information often is withheld responses were (2.2)% strongly disagree (10.0)% disagree (12.2)% neutral (57.2)% agree (18.3)% strongly agree. Question 7 you perceived that you often handed work tasks that are not coherence with your work description responses were (11.8)% strongly disagree (15.0) % disagree (13.3)% neutral (65.0)% agree (6.7)% strongly agree. Question 8 you have experienced administrative negative sanctions responses were (1.7)% strongly disagree (12.8)% disagree (6.1)% neutral ( 71.1)% agree (7.8)% strongly agree. Question 9 you have experience ignorance/isolation at your workplace responses were (0)% strongly disagree (4.4)% disagree ( 17.8)% neutral (73.3)% agree (4.4)% strongly agree. Question 10 you have experienced verbal threats at your workplace responses were (.6)% strongly disagree (.6)% disagree (1.7)% neutral (47.2)% agree (50.0)% strongly agree. Question 11 you have experience vandalism towards your personal belongings at your work place responses were (0)% strongly disagree (7.8)% disagree (2.2)% neutral (76.1)% agree (13.9)% strongly agree. Question 12 you have personally experienced violence at your workplace

responses were (0)% strongly disagree (10.6)% disagree (7.8)% neutral(64.4)% agree (17.2)% strongly agree. Question 13 you have been exposed to workplace bullying responses were (.6)% strongly disagree (10.0)% disagree (6.7)% neutral (70.6)% agree (12.2)% strongly agree. Question 14 you have been seen to workers that have been exposed to workplace bullying responses were (0)% strongly disagree (3.9)% disagree (.6)% neutral (61.1)% agree (34.4)% strongly agree.

Table 2. Frequencies of workplace bullying

Questionnaire workplace bullying

(SDA)F (%f)

(DA) F (%)

(N) (%)

(A) F (%)

(SA)F (%)

1. The law of victimization is satisfactory and familiar.

2. Hospital where you work their policies and guidelines fulll the concern of workplace bullying.

3 (1.7)

1(.6)

94 (52.2)

13 (7.2)

37 (18.3)

33 (18.3

88(48.9)

15(8.3)

36(20.0)

40(22.2)

4. During the employment at some point staff should inform that workplace bullying is not satisfactory behavior.

84(46.7)

2(1.1)

18(10.0)

33(18.3)

45(25.0)

25(15.0)

6(3.3)

14(7.8)

102(56.7)

56(31.1)

3. The hospital you work for anyone is educated in questions for workplace bullying.


information about workplace bullying.

5. Your organization has contributed with enough

4(2.2)

91(50.6)

15(8.3)

34(18.9)

36(20.0)


12. You have personally experienced violence at your workplace.

13. You have been exposed to work place bullying.

14. You have been seen coworkers that have been exposed to work place bullying.

0

1(.6)

0

19(10.6)

14(7.8)

116(64.4)

31(17.2)

18(10.0)

12(6.7)

127(70.6)

22(12.2)

7(3.9)

1(.6)

110(61.1)

62(34.4)

(SDA)F (%f)

(DA) F (%)

(N) (%)

(A) F (%)

(SA)F (%)

0

Questionnaire workplace Turnover intention.

Strongly Disagree (SDA). Disagree (DA). Neutral (N). Agree (A). Strongly Agree (SA).

7(3.9)

1(.6) 110(61.1)

62 (34.4)

1. Since your commencements you have thought occasionally nd another job that you should have to.

2. If it is up to you, will still work at hospital in two years.

17(9.4)

61(33.9)

38(21.1)

45(25.0)

19(10.6)

3. As soon as you avail a job another hospital, you must take the chance.

0 5(2.8)

6(3.3)

112(62.2)

57(31.7)

4. Within a short period of time a job should be nding at another hospital.

0 0 3(1.7)

151(83.9)

26(14.4)

Table 3. Frequency Distribution of Turnover Intention

(SDA). Disagree (DA). Neutral (N). Agree (A). Strongly Agree (SA).

According to the table 3. Descriptive analysis about turnover, Question 1 since your commencement you have thought occasionally nd another job that you should have to responses were (0)% strongly disagree (3.9)% disagree (.6)% neutral ( 61.1)% agree (34.4)% strongly agree. Question 2 if it is up to you, will still work at hospital in two years responses were (9.4)% strongly disagree (33.9)%disagree (21.1)% neutral (25.0)% agree (10.6)% strongly agree. Question 3 As soon as you avail a job another hospital, you must take chance responses were (0)% strongly disagree (2.8)% disagree (3.3)% neutral (62.2)% agree (31.7)% strongly agree. Question 4 within short period of time a job should be nding at another hospital responses were (0)% strongly disagree (0)% disagree (1.7)% neutral ( 83.9)% agree (14.4)% strongly agree. Reliability: Cronbach's alpha is used for measure to scale reliability . the alpha values of work place


6. You perceived that work related information often is withheld.

7. You perceived that you often handed work tasks that are not coherence with your work description.

8. You have experienced administrative negative sanctions.

9. You have experienced ignorance/isolation at your workplace.

10. You have experienced verbal threats at your workplace.

11. You have experienced vandalism towards your personal belongings at your workplace.

4(2.2)

22(11.8)

3(1.7)

0

1(.6)

0

18(10.0)

22(12.2)

103(57.2)

33(18.3)

27(15.0)

24(13.3)

117(65.0)

12(6.7)

23(12.8)

11(6.1)

129(71.7)

14(7.8)

8(4.4)

32(17.8)

132(73.3)

8(4.4)

1(.6)

3(1.7)

85(47.2)

90(50.0)

14(7.8)

4(2.2)

137(76.1)

25(13.9)


bulling and turnover intention were above 0.6 which were acceptable. Its means the internal reliability of the scale was accurate.

S.NO Variable of study No. of itemsCranbach's

alpha

01 02

Workplace bullying & turnover intention

18 .634

Table 4. Summary of KMO Bartlett's assumptions

According to the table 4. Validity:Instrument was consisted on total 18 items. 1, is Workplace bullying, independent variable and 2 turnover intention is dependent variable. Furthermore all statement of factor analysis was fullled and Bartlett's test must be signicant so total set criteria were fullled.

Bartlett's Test

Work place bullyingTurnover intention

KMO.747.500

Approx. 569.51215.818

Df911

Sig.000.000

Table 5. Summary of KMO Bartlett's assumptions

Regression analysisAccording to the table 5, Regression analysis was used to examine the relationship between variables. To determine the effect on nurses' workplace bullying on turnover intention and many regressions was used to examine the hypothesized relationships. Value of r square was used to explain the amount of variance same thing is explained by adjusted r square and in a more accurate way.

B SE B P

Constant

Workplace bullying

R²=.085

∆R².080

11.058 1.133

.089 .022 .292 .000

Table 6. Results of the Main effect Hypotheses; Nurses workplace bullying on turn over intention

DISCUSSION

The aims of this study were to evaluate the association of work place bulling and turnover intention. The association between the workplace bullying and the turnover was resolute in different organization (18-20). In this study work place bullying have impact on turnover of nurses working in private hospitals. Many previous studies conducted on this workplace bullying and turn over intention that shows positive relationship (Hogh, Hoel, & Carneiro, 2011). This study supports the hypothesis which has the positive relationship between workplace bullying on turnover intention. Identied the workplace bullying behavior towards the health care workers on turnover intention correlation analysis was applied. It can be seen in correlation table that there is signicant relationship. According to this study some have experienced verbal threats at workplace (Baran,, Shanock, & Miller, 2012). It is a manager's responsibility to direct the workers through a crisis. The managers recognize that they do not have enough resources or information on how to deal with workplace bullying; it can be value reecting over how organized the managers are to guide the employees (Heponiemi, Kouvonen,, Virtanen, Vänskä, & Elovainio, 2014). . In this study mostly employs experience ignorance/isolation at their workplace, Health care professionals, including physicians, encountered workplace violence (Heponiemi, Kouvonen,, Virtanen, Vänskä, & Elovainio, 2014). According to this responses ignorance is the main reason in which person feel disgrace at workplace. In dependent variables Question 3 As soon as you avail a job another hospital you must take chance mostly were agree, in one study, responses were 0% strongly disagree 2.8% disagree 3.3 % neutral 62.2% agree 31.7% strongly agree. Question 4 within short period of time a job should be nding at another hospital responses were 0 % strongly disagree (0) % disagree 1.7% neutral 83.9 % agree 14.4%


Bohdanowicz, P., Zientara, P., & Novotna, E.

bullying and turnover intentions in the nursing workplace. Journal of Nursing Management, 23(8), 1106-1114.

(2011). International hotel chains and environmental protection: an analysis of Hilton's we care! programme (Europe, 2006–2008). Journal of Sustainable Tourism, 19(7), 797-816.

Cortina, J. M. (1993). What is coefcient alpha? A n e x a m i n a t i o n o f t h e o r y a n d a p p l i c a t i o n s . J o u r n a l o f a p p l i e d psychology, 78(1), 98.


strongly agree. According to this response nurses were not satised to more work in this environment they needs to better opportunity. Table 4. Presents Cronbach's alpha. Cronbach alpha is used for measure to scale reliability (Cortina,. 1993). The alpha values of work place bulling and turnover intention were above 0.6 which were acceptable. Its means the internal reliability of the scale was accurate. To determine the effect on nurses' workplace bullying on turnover intention and many regressions was used to examine the hypothesized relationships. Value of r square was used to explain the amount of variance same thing is explained by adjusted r square but in a more accurate way. To determine the relationship between independent variable (workplace bullying) and dependent variable (Turnover intention) correlation analysis was done. The results are described with the help of parsons' coefcient of co relation (r) and the value of signicance (p). Correlation are signicant at the levels of p =0.01. In one study of Kaushalya, revealed that there was signicant association between the workplace bullying and the turnover intention among nurses Kaushalya, S. A. H., & De Alwis, A. C. (2015). Simons study expose that 31% subjects stated being bullied and it is important cause to leave the institute (B=3.1, Pc < .0005) (Simons, 2008).

CONCLUSION

nurses' commitment level to their work performance. The outcome of this study specify that in combination with developing new policies and ofcial and unofcial injustice actions, taking steps to provide a positive work environment with appropriate attention to staff support structures may be an effective way of protecting people's health and welfare in the workplace. The effect of the workplace bullying behavior on turnover intention was evaluated in study. Today the harassment is a bad situation in many organizat ions . Furthermore, the individual experiences low level of workplace bullying behavior shows better work other than that experienced bullying behavior. In the same way, while the pleased staff will possibly show better output.

Baran, B. E., Shanock, L. R., & Miller, L. R. (2012).

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