Evaluation of the relationship between time management and professional self-efficacy with quality of nursing care in nurses of northwest Iran

doi:10.21203/rs.3.rs-4214245/v1

Aims

The present study aims to evaluate the relationship between time management and professional self-efficacy with the quality of nursing care in nurses of northwest Iran.

Background

Nowadays time is a vital factor in medical interventions. Time management and self-efficacy are crucial for retrieving the best nursing care standards.

Methods

This correlational study was conducted in Ardabil, northwest of Iran, in 2023. In these 350 nurses have been categorized by stratified sampling method. For data collection, we used Raj’a Nayef Zyoud's(2023) time management inventory, Masoumeh Bakhtiari et al(2023) professional self-efficacy of nurses inventory, and Anita Karaca et al(2022) nursing care quality inventory. The collected data were analyzed in SPSS software (26) using descriptive statistics, independent t-test, analysis of variance, Pearson correlation coefficients, and linear regression stepwise model.

Result

The results revealed that Time management (80.3%), Professional Self-efficacy (61.7%), and Quality of nursing care (57.1%) were at a moderate level. Also, the mean value of the time management score, professional self-efficacy score, and nursing care quality score were (59.79 ± 10.37), (72.64 ± 12.34), and (45.151 ± 16.78), respectively. There was a meaningful relationship between time management and professional self-efficacy with the quality of nursing care (p < 0.001). The stepwise multiple linear regression model showed that time management (65%) was a stronger predictor than professional self-efficacy (62%) on the quality of nursing care.

Conclusion

contributing nurses in this study had shown a medium level of nursing care. We suggest that medical politicians conduct workshops to upgrade time management skills and the professional self-efficacy of nurses so that the quality of nursing care improves as well.

Time management

Professional self-efficacy

Quality of nursing care

Nursing is an occupation that is directly related to people from every layer of society and for that reason, it requires spending sufficient time and energy in every patient’s care and treatment. We call a nurse a professional, useful, and efficient individual when they can conduct care standards practically and pay special attention to time and its importance in nursing care [1–3]. Time management is an important part of patient care and the most important part of optimal management of patients. Time management relies on three factors planning, organization, and control [4, 5]. The goal of conducting a time management policy is to discipline work plans and avoid wasting time, so the most important required action in loyalty to this policy is to educate nurses about time management [6, 7]. Some positive points of time management consist of increasing effectiveness and efficacy, decreasing stress, increasing creativity potential, conducting nursing care with proper quality, and increasing satisfaction of nurses [8–11]. It seems that from all of the factors affecting time management and nurses’ performance, the professional self-efficacy of the nurses has the most effect. In this direction, the cognitive-social thesis of Bandura illustrates a view from human behavior that self-efficacy is its most important part [12, 13]. Self-efficacy is a personal trait and a control mechanism that helps individuals conduct their duties properly and move toward their goals with strong steps. Bandura confirms that four factors are important in upgrading professional self-efficacy: experience of mastership in their field, social algorithms, verbal encouragement, and individual state of emotion or physiology [14–16]. Also, studies suggest that nurses with higher self-efficacy present a higher quality of nursing care. And in the tensions and tough situations they are more flexible and resistant [17–20]. nurses with low self-efficacy are stressed people and when a stressful situation comes up, instead of trying to solve the situation, they try to avoid it. For this reason, they face professional tension and eventually moral tension [21–25]. Based on Rostam pour’s report, the result of Etebari and colleagues suggests that nurses with higher self-efficacy, present with higher clinical and professional performance and also pay special attention to their profession therefore they grant high-quality nursing care [26]. To this day, all the results of conducted studies until this day, suggest that nurses with better time management and higher professional self-efficacy improve their practical abilities in nursing care and, eventually, increase the quality of nursing care quality [27]. Quality of nursing has always been an important principle of nursing, creating challenges for researchers and experts in this field [28, 29]. The main purpose of providing quality-based care is to provide the best care possible for patients. On the other hand, it grants higher satisfaction of both patient and nurse about care that has been taken, because services have been provided in higher sensitivities and possible problems have been dealt with [30, 31]. Because care is the heart of nursing and the capability of conducting general care procedures scientifically and in its proper time is the key to returning patient’s life, it has always been a question in the researcher’s mind whether time management, professional self-efficacy, and high nursing care quality are effective factors or not. On the other hand, researchers didn’t find any research that evaluates the relationship between time management and professional self-efficacy with the quality of nursing care. This study aims to determine the relationship between time management and professional self-efficacy with the quality of nursing care in northwest Iran.

Purpose of study

this research aims to determine of relationship between time management and professional self-efficacy with the quality of nursing care in nurses of northwest Iran.

Study design

this study was conducted in the 5 hospitals of the city of Ardabil and on their nurses, in 2023. Ardabil is a major city in the northwest of Iran. The sample size has been determined via the equation mentioned below and with a confidence interval of ( 95%). The statistical power of the test was 80% and based on the result of Heidari and colleagues’ study, with 350 nurses, the correlation coefficient between time management and professional self-efficacy is (r = 0.15). sampling method was a random stratified method [32].

Participants

The sampling method was the random stratified method. Inclusion criteria consist of at least one year of experience in clinical endeavor and showing legal agreement about participation in our study. Also, exclusion criteria were to fill our presented inventories incompletely.

Data collection

our data collection instrument was a four-parted inventory

a. Personal-social identification of nurses: such as sex, marital status, job experience, department of occupation, level of satisfaction about their job, experience of occupation in their current department, etc.
b. Time management inventory of the nurses: this inventory was designed by Raj’a Nayef Zyoud (2023) [33]. It consisted of 17 questions in Likert 5-point scale form and was scaled from 1 to 5 respectively. The range of scores is from 17 to 85.

This inventory consists of three dimensions:

1. organizing (questions 1 to 7)

2. setting goals and planning for activities (questions 8 to 13)

3. coordination (questions 14 to 17)

Their face and content validities were confirmed by ten university faculty members using the Waltez and Basel technique (CVR = 0.9, CVI = 0.89). The reliability and validity of the instrument have been validated by the researcher. Cronbach’s alpha = 0.95[33]. also In the current study, the reliability of the instrument has been retrieved with Cronbach’s alpha = 0.9.

c. Self-efficacy inventory of the nurses: this inventory has been designed by Pulit and colleagues (2016) [34]. This has been psychoanalyzed by Barkhordari and colleagues in Iran (2023) [35]. This inventory consisted of 19 questions in the Likert 5-point scale form and was scaled from 1 to 5 respectively. The range of scores is from 19 to 95.

This instrument has three dimensions:

1. Care situation (question 1 to 6)
2. Support situation (question 7 to 11)
3. Professional situation (question 12 to 19)

The validity of the main inventory is 0.79 and the validity of Cronbach’s alpha is 0.93[34,35]. In the current study, the reliability of the instrument has been retrieved with Cronbach’s alpha = 0.93

d. Nursing care quality inventory: this inventory has been designed by Liu and colleagues (2021) [36] and has been psychoanalyzed by Anita Karaca in Turkey (2022) [37]. This questionnaire consists of 38 questions in the Likert 5-point scale form and scaled from 1 to 5 respectively. The range of scores is from 38 to 190.

This inventory has 6 dimensions:

1. Physical environment (question 1 to 6)
2. Staf characteristics (questions 7 to 14)
3. Precondition (question 15 to 21)
4. Task-orientated activities (questions 22 to 27)
5. Human orientated activities (questions 28 to 32)
6. Patient outcomes (questions 33 to 38)

Their face and content validities were confirmed by ten university faculty members using the Waltez and Basel technique (CVR = 0.93, CVI = 0.92). The validity and reliability of the instrument have been validated by the researcher. Cronbach’s alpha = 0.99[36,37]. In the current study, the reliability of the instrument has been retrieved by Cronbach’s alpha = 0.92.

The rule of quartiles was used to determine the Time management and Professional Self-efficacy with Quality of nursing care. The mean scores of questions related to Time management and Professional Self-efficacy with Quality of nursing care and their sub-components were compared with the criterion score. The following formula was used to calculate the criterion score:

The maximum score minus the minimum score is divided by two plus the minimum score [38].

Data analysis

The data were entered into SPSS-26 software. Qualitative variables were displayed as frequencies, and mean and standard deviation were calculated for quantitative variables. One-sample t-tests, independent t-tests, and one-way analysis of variance were used to investigate the relationship between the socio-demographic characteristics of nurses and Time management, professional self-efficacy, and Quality of nursing care. Also, the Pearson-Spearman correlation coefficient test and linear regression stepwise model were used to investigate the relationship between Time management and professional self-efficacy with Quality of nursing care.

The results showed that the average age of the participants was 32.78 ± 7.11 years, with 59.1% being female and 62.9% being married. The majority of them had a bachelor's degree (87.7%). Other demographic information is presented in Table 1. Among the samples, 80.3% reported good time management skills, 61.7% reported moderate professional self-efficacy, and 57.1% reported moderate quality of nursing care. The average scores for time management, professional self-efficacy, and quality of nursing care from the participants' perspective were 45.3 ± 16.78, 72.64 ± 12.34, and 59.79 ± 10.37, respectively (Table 2).

The results indicated a positive correlation between age and work experience with time management, professional self-efficacy, and quality of nursing care. This relationship was statistically significant (P < 0.05). Additionally, a significant relationship was observed between gender and workshop attendance with time management, professional self-efficacy, and quality of nursing care (P < 0.05) (Table 3).

The results showed a positive and significant correlation between time management (r = 0.47) and professional self-efficacy of nurses (r = 0.44) with the quality of nursing care (P < 0.001). Linear regression analysis was used to examine the relationship between the study variables and the quality of nursing care among nurses (Table 4).

The results indicated that all variables had a significant effect on the quality of nursing care. However, among them, time management accounted for 22% and professional self-efficacy accounted for 20% of the variance in nursing care quality (Table 4).

Table 2. Status of distribution and average time management score, nurses' self-efficacy, and quality of nursing care in the studied groups

Table 3. Relationship between Time Management, Professional self-efficacy, and Quality of Nursing care with their demographic variables

variables		Time Management	P-value	Professional self-efficacy	P-value	Quality of Nursing Care	P-value
gender	female	60.74 ± 10.1	0.03	73.72 ± 12.87	0.04	152.94 ± 18.56	0.03
gender	male	58.41 ± 10.64	0.03	71.07 ± 11.38	0.04	149.3 ± 13.58	0.03
marital status	single	59.72 ± 10.74	0.99	70.84 ± 12.59	0.11	148.94 ± 17.6	0.09
	married	59.83 ± 10.25		73.7 ± 12.18		152.94 ± 16.23
	others	60 ± 6.05		71.5 ± 6.85		148.5 ± 13.89
Education	BSc	59.47 ± 10.39	0.11	72.76 ± 12.13	0.63	151.44 ± 17.07	0.98
Education	MSc	62.11 ± 10.02	0.11	71.81 ± 13.82	0.63	151.51 ± 14.76	0.98
Shift	Morning	60.3 ± 10	0.21	73.2 ± 12.17	0.52	152.02 ± 18.64	0.8
	Evening	58.92 ± 8.52		71.97 ± 9.6		150 ± 11.01
	Night	57 ± 9.46		70.26 ± 10.21		149.8 ± 11.24
	Circus	60.45 ± 11.07		73.12 ± 13.42		151.92 ± 18.07
Participation in workshop	Yes	60.76 ± 8.3	0.03	74.81 ± 9.35	0.001	152.84 ± 15.33	0.03
Participation in workshop	No	57.76 ± 13.55	0.03	68.1 ± 16.11	0.001	148.53 ± 19.22	0.03
Age		0.13 =r	0.01	0.16=r	0.002	0.16=r	0.002
Work experience		0.1 =r	0.04	0.13=r	0.01	0.1=r	0.04

Table 4. Predicting quality of nursing care based on Nursing time management, Professional self-efficacy, and demographic variables

predictor variable	R	R²	F	unstandardized β coefficient	SE	standardized β coefficient	T	P
Time management	0.47	0.22	0..25	0.76	0.07	0.47	10.01	0.001
organization	0.21	0.04	16.19	0.76	0.19	0.21	4.02	0.001
planning and goal setting	0.39	0.15	63.53	1.95	0.24	0.39	7.97	0.001
coordination	0.49	0.24	115.63	1.61	0.15	0.49	10.75	0.001
Professional self-efficacy	0.44	0.2	87.45	0.61	0.06	0.44	9.35	0.001
Professional situation	0.38	0.14	60.47	1.35	0.17	0.38	7.77	0.001
Care situation	0.34	0.11	46.05	1.48	0.21	0.34	6.78	0.001
Support situation	0.41	0.17	71.41	1.2	0.14	0.41	8.45	0.001
Gender	0.1	0.01	4.01	3.64	1.81	0.1	2	0.04
Age	0.16	0.02	9.72	0.38	0.12	0.16	3.11	0.002
work experience	0.1	0.01	3.97	0.24	0.12	0.1	1.99	0.04
Participation in workshop	0.12	0.01	5.12	4.31	1.9	0.12	2.26	0.02

The study aimed to determine the relationship between time management, professional self-efficacy, and the quality of nursing care among nurses in Western Iran. The participants reported moderate levels of time management (80.3%), which is consistent with the findings of studies conducted by Yunitasari et al (2022), Hashemizadeh et al (2013) and Heydari et al(2012) [32, 39, 40]. In contrast, a study by Barua et al. (2019) in Bangladesh reported poor time management among nurses, which differs from the current study's findings [41]. This difference may be attributed to cultural, social, and managerial factors prevailing in the respective nursing units.

In this study, nurses reported a self-efficacy rate of 61.7%, which is consistent with the findings of Alizadeh et al. (2020), Shamsifar et al. (2020), and Nasirizadeh et al (2023) [42–44]. The average self-efficacy score of nurses in this study was higher than the study conducted in Korea, with a mean and standard deviation of 35.66 ± 4.5 compared to a mean score of 30.67 ± 3.42 [23, 45]. This difference in results can be attributed to social factors and individual-environmental factors, according to Bandura's theory. This study was conducted in Ardabil, Iran, which has different culture and environmental conditions compared to England and Korea [46].

In the present study, nurses reported an average score of 57.1% for the quality of nursing care, which is consistent with the findings of Jafarjalal et al. (2023), Jamsahar et al. (2020), and Azim Lolati et al. (2021) [47–49]. However, it contradicts the findings of Pasandideh et al. (2017) and Dabirian et al. (2008), which showed a low level of nursing care quality according to the perspectives of nurses and patients [50, 51]. This difference may be attributed to the type and number of samples and the prevailing management in the related units.

In the study, a significant relationship was found between time management and gender, work experience, and age, which is consistent with the findings of Ziapour et al. (2015) and inconsistent with the study by Hashemizadeh et al. (2013) [40, 52]. This difference may be attributed to the socio-cultural context and the management practices in the nursing units.

In Ibrahim et al.'s study (2014), a significant relationship was found between time management and the duration of time management courses, while in Heidari et al.'s study (2023), this relationship was not significant [32, 53].

In the present study, a significant relationship was observed between the professional self-efficacy of nurses and gender, work experience, age, and participation in time management workshops, which is consistent with the findings of Pourfarzad et al. (2019) [54].

In the current study, a significant relationship was found between age, participation in workshops, and work experience with the quality of nursing care, which is consistent with the studies conducted by Abdian et al. (2023), Pahlavanzadeh et al. (2020), and Moghaddam et al. (2012) [55–57].

The findings indicated a significant and positive correlation between time management and the professional self-efficacy of nurses with the quality of nursing care, which is consistent with the study conducted by Rokhafroz et al. (2020). However, no significant relationship was found between self-efficacy and the quality of nursing care from the perspective of nurses in the current study [3].

Limitation

One of the limitations of this study was the use of the self-reporting method and not having enough time to complete the questionnaire. Accordingly, the researcher tried to solve the problem by selecting the right time, allocating enough time, explaining the importance of the study objectives, and emphasizing this issue.

Overall, the results demonstrated a significant and positive relationship between time management and professional self-efficacy with the quality of nursing care. The stepwise multiple regression model showed that time management had a stronger impact on the relationship between professional self-efficacy and the quality of nursing care. The status of time management, professional self-efficacy, and the quality of nursing care was at a moderate level. Therefore, healthcare decision-makers should take necessary measures, such as organizing educational workshops and justification programs, to enhance time management and professional self-efficacy and their impact on nursing care.

In addition to these findings, it was shown that nursing time management and professional self-efficacy were more important predictors compared to other variables in predicting the quality of nursing care.

Acknowledgments

The present study is a project approved by the Student Research Committee of the School of Nursing and Midwifery, Ardabil University of Medical Sciences, with the code of ethics IR.ARUMS.REC. 1402. 160. The researchers consider it necessary to thank all the We hereby appreciate The Nursing and all those who helped the researchers in conducting this research.

Authors’ contributions

B. D. conceptualized the study; B. D. and MA. M. supervision data collection; MA. M.

Database search strategy; S.KH. and M. M. the data and drafted the first version of the manuscript; S. KH and M. M. reviewed and edited the manuscript; all authors read the revised manuscript and approved the final version

Funding

Not applicable.

availability of data and materials

The datasets used and analyzed during the current study are available from

the corresponding author upon reasonable request

Ethics approval and consent to participate

This study strictly followed the principles outlined in the Declaration of Helsinki. The present study is a project approved by the Student Research Committee of the School of Nursing and Midwifery, Ardabil University of Medical Sciences, with the code of ethics IR.ARUMS.REC. 1402. 160. All participants provided written informed consent before the commencement of the study. The consent form gave the participants a clear understanding of the study’s purpose and methods. Participants were also informed of the researchers’ commitment to address any questions or concerns and the confidentiality of their information.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests

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No competing interests reported.

Evaluation of the relationship between time management and professional self-efficacy with quality of nursing care in nurses of northwest Iran

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Abstract

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