The mediating role of professional values and self-efficacy in the relationship between organizational justice and quality of working life among nurses in southwestern Iran

doi:10.21203/rs.3.rs-4926221/v1

Background: An optimal quality of working life (QWL) is crucial for the preservation and maintenance of employees. Organizational justice, as a significant organizational factor, leads to the improvement and enhancement of QWL in organizations, which can in turn promote organizational commitment, job satisfaction, and ultimately increased productivity. One variable that can be influenced by organizational justice is self-efficacy, which strengthens the flexibility of nurses in challenging operating room environments. Professional values form the foundation of the nursing profession, enabling nurses to manage conflicts and prioritize actions. The purpose of this study was to determine the relationship between organizational justice and quality of work life, with an emphasis on the mediating role of professional values and self-efficacy among the operating room and anesthesia nurses.

Methods: This cross-sectional study was conducted in Iran in 2023.Via convenience sampling, 376 operating room and anesthesia nurses participated in this study. Data were collected in person using five questionnaires: demographic characteristics, organizational justice (Niehoff & Moorman), quality of work life (Walton), professional values (Schank & Weis), and job self-efficacy (Riggs).

Results: 376 operating room and anesthesia nurses with a mean age of 33.92 ± 7.02 years and a mean work experience of 9.98 ± 7.76 years participated in the study. The majority were female (60.6%). According to the results of structural equation modeling, the mediating variables of professional values (T-values = 7.11) and self-efficacy (T-values = 4.46) had a statistically significant effect on the correlation between organizational justice and nurses' QWL. The results of the Sobel test and Variance Accounted For (VAF) statistics also confirmed the mediating role of professional values and self-efficacy in the relationship between organizational justice and QWL.

Conclusion: Organizational justice not only directly impacts QWL but also indirectly affects it through professional values and self-efficacy. Policymakers in the healthcare system and hospital managers can enhance QWL and promote a fairer work environment in operating rooms by increasing their self-efficacy levels and respecting nursing professional values.

Organizational justice

quality of working life (QWL)

professional values

self-efficacy

operating room nurses

anesthesia nurses

Nowadays, the success and achievement of organizational goals heavily depend on the performance level of employees (1). The presence of an optimal Quality of Working Life (QWL) in healthcare system is a very important factor for retaining motivated, skilled, and high-quality employees (2).

Quality of work life is a subjective phenomenon influenced by personal perceptions and feelings. It refers to attitudes toward one's job, overall satisfaction with work life, and a sense of value and respect within the organization (3).

An optimal level of quality of working life enables healthcare workers to provide high-quality services to patients. This is only possible if they enjoy mental health, job satisfaction, and satisfaction in various aspects of life. Therefore, the quality of working life for a nurse, as someone who cares for others in the community, requires special attention (4).

One of the key organizational factors that contributes to the improvement and enhancement of quality of work life is organizational justice (5). It refers to individuals' subjective perceptions of fairness in the allocation of resources, rewards, and punishments, and it is a multidimensional construct (6). Organizational justice can lead to increased organizational commitment, and job satisfaction, and ultimately enhance efficiency and productivity (7). One of the most serious and common issues faced by nurses is the perceived discrimination between them and physicians (8). Perceived discrimination in healthcare settings can reduce the quality of care, increase healthcare costs, decrease job satisfaction, undermine staff morale, and may finally lead to intentions to leave the job (9-11).

Among the variables that can be effected by organizational justice is the feeling of self-efficacy (12). Self-efficacy is defined as an individuals’ judgment about their ability to perform essential tasks within a specific job and profession (13). And it consists of the factors used to strengthen the flexibility of nurses in the challenging environment of the operating room (14). Self-efficacy plays a crucial role in nurses' professional performance and is a significant predictor of their behaviors. Therefore, high self-efficacy positively affects individual performance and, ultimately, the efficiency and effectiveness of the organization (13).

One of the most important factors that improve the quality of life, job satisfaction, and organizational commitment among nurses is their perception of the values of the nursing profession (15, 16). Values are ideals and beliefs that shape behaviors and provide a foundation for decision-making and action. Professional values are standards for practice that are accepted by the professional group and caregivers and provide a framework for evaluating the values and beliefs that influence behavior (17).

Professional values form the foundation of the nursing profession and enable nurses to deal with conflicts and prioritize actions (18). Professional values include concepts such as care based on humanism, fairness, and justice. According to this perspective, nurses consider themselves obligated to adhere to professional values regardless of their position or educational level (19).

Operating room nurses always deal with special professional challenges in the stressful, sensitive, and extensive environment of their profession (20). Success in surgery, besides the factors including capability, technical skills, and knowledge of the surgeon and the operating room nurses, requires the nurses' mental and emotional calmness, and sense of job satisfaction (14). It seems that one of the current mental concerns of nurses working in the operating room is the lack of justice between them and physicians, which can impact their QWL.

The review of the related literature showed that no study was found focusing on examining the mediating role of professional values and self-efficacy in the relationship between organizational justice and QWL in operating room nurses. Therefore, the present study aimed to investigate the relationship between organizational justice and QWL, emphasizing the mediating role of professional values and self-efficacy among operating room and anesthesia nurses.

2 − 1 Study Design and Participants

This cross-sectional study was conducted in the teaching hospitals of the largest southern city of Iran in 2023. The research population consisted of all operating room and anesthesia nurses working in Shiraz teaching hospitals, who, due to geographical proximity, and availability at a specific time and place, were selected via convenience sampling method from Nemazi (n = 118), Khalili (n = 57), Shahid Faghihi (n = 63), Shahid Rajaii (n = 79), Shahid Chamran (n = 36), and Amir Almomenin (AS) hospitals (n = 23), totaling 376 individuals. The sample size was calculated via the sample size determination website (https://www.danielsoper.com/) with a 5% error rate, 80% power, effect size (d = 2.0), 4 hidden variables (4 questionnaires), and 112 observable variables (the number of questions in the questionnaires), resulting in a sample size of 341 individuals. Considering a 10% drop, we determined 376 individuals.

After obtaining the necessary permissions and approvals from the nursing office of each hospital, data collection was carried out using face-to-face visits from September 20th to December 19th, 2023. For this purpose, the objectives were explained to the nurses during their break time in the operating room workplace, and they were invited to cooperate after meeting the criteria for entering the study. Inclusion criteria for this study consisted of having at least an Associate degree in operating room or anesthesia nursing, at least 6 months of work experience, and willingness to participate in the study. Also, changing the workplace of nurses and incomplete completion of questionnaires were considered as the exclusion criteria.

2–2 Data Collection Tools

Data were collected using five questionnaires: Demographic Characteristics, Organizational Justice (Niehoff and Moorman), Quality of Working Life (Walton), Professional Values in Nursing (Schank & Weis), and Self-Efficacy (Riggs et al.).

1-2-2- Demographic Characteristics Questionnaire

This questionnaire included questions on age, gender, marital status, level of education, and work experience.

2-2-2 Organizational Justice Questionnaire

The Niehoff and Moorman Organizational Justice Questionnaire (1993) was designed in the United States. This questionnaire consists of 20 items and is divided into three dimensions: distributive justice, procedural justice, and interactional justice. A five-point Likert scale (ranging from strongly disagree to strongly agree) was used for scoring. Questions 1–5 assess distributive justice, 6–11 procedural justice, and 12–20 interactional justice. The minimum score on this questionnaire is 20, and the maximum score 100. A score between 20–35 indicates low, 36–44 moderate, and a score above 45 indicates high organizational justice. This tool was based on one used by Moorman (1991) and had reported reliabilities above 0.90 for all three dimensions (21).

In Iran, the content validity of the questionnaire was confirmed by experts and specialists in organizational behavior management. The validity of this questionnaire was confirmed through the opinions of professors and experts, and its reliability was assessed through Cronbach's alpha coefficients: 0.921 for overall organizational justice, 0.915 for distributive justice, 0.768 for procedural justice, and 0.871 for interactional justice, as confirmed in Bahrami et al.'s study (22).

2-2-3 Quality of Working Life Questionnaire

The Walton Quality of Working Life Questionnaire, developed in 1975 in the Netherlands to assess QWL, consists of 35 questions across 8 dimensions. These dimensions include Fair and Adequate payment (questions 1 to 4), Safe and Hygienic Work Environment (questions 5 to 10), Development of Human Capabilities (questions 11 to 15), Opportunity for Growth and Continued Security (questions 16 to 19), Integration and Cohesion (questions 20 to 23), Legalism (questions 24 to 27), Overall Life Environment (questions 28 to 30), and Social Dependency in Working Life (questions 31 to 35). Scoring is based on a Likert scale ranging from strongly dissatisfied to strongly satisfied, with a minimum possible score of 35 and a maximum of 175. Scores between 35 and 58 indicate low quality of working life, scores between 59 and 118 indicate moderate quality, and those above 118 indicate high quality of working life. Walton reported the reliability of the questionnaire with Cronbach's alpha coefficient of 0.88 (23). In the study by Fakhrpoor et al., the QWL questionnaire's validity was confirmed with a coefficient of 0.88, and Cronbach's alpha was calculated at 0.95 (24). Additionally, in the study by Khanzadeh et al., the validity of the Walton Quality of Working Life questionnaire was confirmed by ten faculty members from the School of Nursing and Midwifery at Tehran University of Medical Sciences, and the reliability of the tool was confirmed with a Cronbach's alpha coefficient of 0.84 (25).

2-2-4 Nurses' Professional Values Questionnaire

The Nursing Professional Values Questionnaire, designed by Schank and Weis in 2001 to measure professional values in the United States, consists of 26 components based on the ethical codes of the American Nursing Association and is divided into five dimensions: Dimension of Care (9 items, questions 1 to 9), Pragmatism (5 items, questions 10 to 14), Trust (5 items, questions 15 to 19), become a Professional (4 items, questions 20 to 23), and Justice (3 items, questions 24 to 26). The questionnaire uses a five-point Likert scale, ranging from "Not Important" to "Very Important," with scores ranging from 26 to 130; higher scores indicate a greater familiarity with professional values. In the study by Schank and Weis, construct validity was evaluated with a total factor load of 0.79 in five areas of care, pragmatism, trust, become a professional and justice (26). In Iran, for the first time, this questionnaire was translated and its validity and reliability was measured by Parvan et al. and the Cronbach's alpha coefficient of the tool was calculated as 0.91 in this study (17). In the study of Schank and Weis, the alpha coefficient of the total scale was calculated as 0.92, and the validity of the construct was supported with an overall factor loading from 0.46 to 0.79 in the five dimensions of care, pragmatism, trust, becoming a professional, and justice (26). Additionally, study by Aghaeenezhad et al. confirmed the reliability of the tool with a Cronbach's alpha of 0.80 (27).

5-2-2 Self-Efficacy Questionnaire

The Self-Efficacy Questionnaire, developed by Riggs et al. in 1994 in the United States, includes 31 questions divided into four dimensions: Individual Self-Efficacy Beliefs (questions 1 to 10), expectation of individual consequences (questions 11 to 18), Collective Self-Efficacy Beliefs (questions 19 to 25), and expectation of collective consequences (questions 26 to 31). Each question is scored on a five-point Likert scale ranging from "Strongly Disagree" (score 1) to "Strongly Agree" (score 5). Reverse-scored questions include questions 2, 3, 4, 6, 8, 10, 12, 14, 17, 20, 21, 23, 24, 25, 28, and 30, where "Strongly Disagree" is scored as 5 and "Strongly Agree" is scored as 1. The minimum and maximum possible scores are 31 and 155, respectively. In interpreting questionnaire data, a mean score above 3 indicates high occupational self-efficacy, while a mean score below 3 indicates low occupational self-efficacy (14).

In Riggs' study (1994), the reliability of this scale was reported to be between 0.85 and 0.88. The validity of the scale was assessed through internal consistency, with correlations between subscales ranging from 0.06 to 0.56, confirming that the individual self-efficacy scale was the most independent measure (28). In a study by Naboureh et al. (2014), content validity was examined and confirmed using a Cronbach's alpha of 0.85(29). In Iran, the content validity of the questionnaire was also confirmed in a study by Khabazi and Momeni the reliability of the questionnaire was confirmed with a Cronbach's alpha of 0.88(30).

3 − 2 Data Analysis

SPSS) Statistical Package for Social Science) version 24 software was used for data analysis, and Smart PLS (Partial Least Squares) version 4 software was used for Structural Equation Modeling (SEM). Mean (standard deviation) was used to describe quantitative data and frequency (percentage) was used to describe qualitative data. The Spearman correlation coefficient was utilized in this study. Structural Equation Modeling was employed to discover direct and indirect relationships among the study variables. The Kolmogorov-Smirnov test was used to assess the normality of the data, and if the data were not normally distributed, non-parametric equivalents of the tests were employed. A significance level of 0.05 was considered for this study.

2–4 Ethical Considerations

This study was approved by the Ethics Committee of Shiraz University of Medical Sciences (Ethics code: IR.SUMS.NUMIMG.REC.1402,025:). All participants consented to participate in the study and signed an informed consent form. Participants were informed about the research objectives, voluntary nature of participation, right to withdraw, and confidentiality of their information.

In the present study, 376 operating room and anesthesia nurses with a mean age of 33.92 ± 7.02 years and a mean work experience of 9.98 ± 7.76 years participated. Most of the participants were female (60.6%), married (59.8%), and held a bachelor's degree (85.1%) (Table 1).

Table 1

Frequency distribution of qualitative demographic variables of the study participants (n = 376)
Variables		Frequency (%)
Gender	Female	228 (60.6)
Gender	Male	148 (39.4)
Marital status	Single	151 (40.2)
Marital status	Married	225 (59.8)
Education	Associate Degree	28 (7.4)
	Bachelor	320 (85.1)
	Masters	28 (7.4)

In the present study, the mean total score of organizational justice among participants was 43.53 ± 4.91, indicating that most participants (57.8%) experienced a moderate level of organizational justice. Additionally, the mean score of QWL among participants was 79.90 ± 6.86, reflecting a moderate level of quality of work life.

According to the Spearman correlation test results, there was an inverse and significant negative relationship between the development of human capabilities in quality of work life and the overall score of organizational justice (P-value = 0.035, r = -0.109). Furthermore, a significant positive relationship was found between the dimensions of growth opportunities and continuous security in quality of work life and the procedural justice, interactional justice, and overall organizational justice scores (P-value = 0.045, r = 0.103; P-value = 0.015, r = 0.125; P-value = 0.001, r = 0.172, respectively). Additionally, a significant positive relationship was observed between the dimension of integrity and coherence in quality of work life and procedural justice (P-value = 0.018, r = 0.122). There was also a significant positive relationship between the dimension of social dependency in quality of work life and distributive justice (P-value = 0.046, r = 0.103). Based on the results of the present study, the mean score of professional values among participants was 112.21 ± 6.87. According to the Spearman correlation test, there was a significant positive relationship between the overall score of professional values and the dimension of distributive justice (P-value = 0.003, r = 0.154), as well as a significant positive relationship with the dimension of interactional justice (P-value = 0.021, r = 0.119) (see Table 2).

Table 2

Correlation between organizational justice and its dimensions with Nurses' professional values and its dimensions
Variable	Distributive justice	Procedural justice	Interactional justice	The total score of Organizational justice
Care	r = -0.042 P = 0/41	r = -0.054 P = 0.29	r = -0.047 P = 0.36	r= -0.079 P = 0.126
pragmatism	r = 0.119 P = 0.021	r = 0.051 P = 0.32	r = 0.106 P = 0.041	r= -0.018 P = 0.73
Trust	r = 0.106 P = 0.041	r = 0.068 P = 0.18	r = -0.037 P = 0.47	r = 0.039 P = 0.45
become a professional	r = 0.136 P = 0.008	r = -0.015 P = 0.76	r = − 0.092 P = 0.076	r = − 0.034 P = 0.51
Justice	r = 0.091 P = 0.077	r = 0.004 P = 0.94	r = 0.001 P = 0.99	r = 0.011 P = 0.84
The total score of nurse's professional values	r = 0.154 P = 0.003	r = 0.056 P = 0.27	r = 0.119 P = 0.021	r = -0.020 P = 0.698

Based on the obtained results, there was no significant relationship between the overall score of quality of work life and professional values among the participants (P-value = 0.86, r = 0.009). Only some dimensions showed a significant relationship, which are detailed in Table 3.

Table 3

The correlation between the QWL and its dimensions with the nurse’s professional values and its dimensions
Variable	Care	Pragmatism	Trust	Become a Professional	Justice	The total score of nursing professional values
Fair and adequate payment	r = − 0.053 P = 0.92	r = − 0.15 P= 0.69	r = − 0.13 P= 0.21	r = − 0.16 P = 0.97	r = − 0.073 P= 0.97	r = − 0.22 P = 0.99
Safe and hygienic work environment	r = 0.011 P = 0.82	r = 0.027 P = 0.60	r = 0.060 P= 0.24	r = − 0.052 P = 0.31	r = 0.020 P= 0.70	r = 0.039 P = 0.45
Development of human capabilities	r = − 0.073 P = 0.16	r = − 0.015 P = 0.77	r = − 0.021 P= 0.68	r = − 0.033 P = 0.53	r = − 0.093 P= 0.071	r = − 0.061 P = 0.23
Opportunity for growth and continuous security	r = − 0.089 P = 0.085	r = 0.019 P = 0.72	r = − 0.022 P = 0.67	r = 0.043 P = 0.41	r = 0.116 P = 0.024	r = − 0.006 P = 0.91
Integration and cohesion	r = 0.003 P = 0.95	r = − 0.059 P = 0.26	r = 0.078 P = 0.13	r = 0.018 P = 0.73	r = 0.058 P = 0.26	r = 0.018 P = 0.73
Legalism	r = 0.035 P = 0.50	r = − 0.256 P < 0.001	r = − 0.220 P < 0.001	r = − 0.279 P < 0.001	r = − 0.152 P = 0.003	r = − 0.323 P < 0.001
Overall life space	r = 0.043 P = 0.41	r = − 0.148 P = 0.004	r = − 0.224 P < 0.001	r = − 0.217 P < 0.001	r = − 0.166 P = 0.001	r = − 0.275 P < 0.001
Social dependence in work life	r =- 0.013 P = 0.80	r = 0.039 P = 0.45	r = 0.030 P = 0.56	r = 0.015 P = 0.77	r = − 0.035 P = 0.50	r = 0.017 P = 0.74
Total QWL* score	r = − 0.007 P= 0.89	r = − 0.013 P = 0.80	r = − 0.039 P = 0.45	r = 0.077 P = 0.14	r = 0.065 P = 0.21	r = 0.009 P = 0.86
* QWL: Quality of working life

The average self-efficacy score among the participants was 103.51 ± 6.26. According to the Spearman correlation test results, there was no significant relationship between the overall organizational justice score and its dimensions with self-efficacy and its dimensions (P-value > 0.05). Regarding the relationship between QWL and self-efficacy, the Spearman correlation test revealed a significant positive relationship between the expectation of collective consequences dimension of self-efficacy and legalism dimension of QWL (P-value = 0.017, r = 0.123). Additionally, a significant negative relationship was observed between the overall life space dimension of QWL and the expectation of collective consequences dimension of self-efficacy (P-value = 0.28, r = -0.114).

In examining the relationship between professional values and self-efficacy among the study participants, the Spearman correlation test revealed significant negative correlations between the care dimension of professional values and the overall self-efficacy score as well as the expectation of collective consequences dimension of self-efficacy (P-value = 0.017, r = -0.123; P-value = 0.034, r = -0.109). Additionally, significant negative relationship were found between the trust dimension of professional values and the overall self-efficacy score and the expectation of collective consequences dimension of self-efficacy (P-value = 0.004, r = -0.123; P-value = 0.035, r = -0.109).

Structural equation modeling (Fig. 1) was used to analyze both direct and indirect relationships among the study variables. The path coefficients for organizational justice to quality of work life, organizational justice to professional values, organizational justice to self-efficacy, professional values to QWL, and self-efficacy to QWL were all statistically significant, with path coefficients greater than 1.96 and at a 95% confidence level (Table 4). The standardized path coefficients indicated that the relationship between organizational justice and quality of work life mediated by professional values was of moderate strength (0.309). Furthermore, the relationship between organizational justice and QWL mediated by self-efficacy also showed a moderate strength (0.215). All test statistics calculated were greater than 1.96, indicating the significance of all direct and indirect path coefficients (Table 4).

Table 4: Direct and indirect paths tested in the structural equation model

The results of the Sobel test and AVF stats also confirmed the above findings; accordingly, the mediating effect of professional values in the relationship between organizational justice and QWL was significant. About 87.2% of the total effect of organizational justice on QWL was explained indirectly by the mediating variable of professional values. Also, the mediating effect of self-efficacy in the relationship between organizational justice and QWL was significant, and approximately 63.9% of the total effect of organizational justice on QWL was explained indirectly by the mediating variable of professional values (Table 5).

Table 5

Hypothesis testing indirect (mediation effect) model of research
Independent variable	Mediator variable	dependent variable	Sobel test	VAF
Organizational Justice	Professional values	QWL*	7.011	0.872
Organizational Justice	self-efficacy	QWL	4.46	0.639
*QWL: Quality of working life

The present study revealed that increasing organizational justice would improve the QWL for operating room nurses. Some dimensions of these two variables were also found to be related to each other. Gharcheh et al. focused on predicting the QWL based on the dimensions of organizational justice in nurses; according to the results, a significant direct relationship was observed between the quality of life and the procedural, distributive, and interactional dimensions of organizational justice (2).

In the study by Gillet et al., distributive and interactional justice had a significant effect on the QWL of nurses and could act as good mediators between transformational leadership and nurses' QWL (31). Also, Aminbeidokhti and Mardani found that there was a positive and significant relationship between the distributive and procedural dimensions of organizational justice with participation in the study, but there was no relationship between interactional justice and QWL (32).

According to the results of the present study, there was a direct relationship between the professional values of operating room nurses and their distributive organizational justice, and an inverse relationship was observed with their interactional justice. In our structural Equation Modeling, we found that the professional values of nurses had an impact on their organizational justice and could be a good mediator in the relationship between organizational justice and nurses' QWL. Tehranineshat et al. found that the professional values of nurses under study had a meaningful relationship with all dimensions of their professional life quality (33).

In the current study, based on the correlation analysis between organizational justice of nurses and its dimensions with self-efficacy, we did not find any significant relationship. However, structural equation modeling confirmed a direct relationship between them. Self-efficacy in the present study could also be a good mediator in the relationship between organizational justice and nurses' QWL. In a study, Ahmed Mohamed Ebrahim et al found that organizational justice had a strong and significant direct relationship with the self-efficacy of nurses, and variables including the level of education, innovation, and organizational justice had a positive impact on self-efficacy (34).

Chegini et al. also found that self-efficacy played a good mediating role in the relationship between organizational justice and nurses' organizational commitment (35). The results of the present study showed that in examining the relationship between self-efficacy and the quality of work life of nurses among the various dimensions of nurses' self-efficacy, the expectation of collective consequences dimension of self-efficacy had a significant direct relationship with the legalism dimension of QWL and a significant reverse relationship with the overall life space dimension of QWL. In addition, Structural Equation Modeling confirmed a direct relationship between self-efficacy and QWL. Self-efficacy in the current study could also be a good mediator in the relationship between organizational justice and nurses' QWL. Orgambidez et al. sought to uncover the relationship between self-efficacy and QWL among nurses and used job involvement, job satisfaction, and organizational commitment as indicators of QWL. They found a positive and significant relationship between self-efficacy, job involvement, job satisfaction, and organizational commitment. In their study, also job involvement acted as a relatively good mediator between self-efficacy and job satisfaction, and job satisfaction acted as a good mediator between self-efficacy and organizational commitment (36).

In examining the relationship between professional values and self-efficacy of participants in the current study, a reverse relationship was observed between the dimensions of care and trust of professional values with the total score of self-efficacy and the expectation of collective consequences of self-efficacy. Dellafiore et al. examined the relationship between professional values and nurses' self-efficacy and found a significant positive relationship between all domains of both variables (37). Also Magharei et al. showed positive and significant relationships between quality of professional life and organizational commitment (38).

Based on the results of this study, Structural Equation Modeling, contrary to the correlation test at the beginning, revealed that an increase in perceived organizational justice by participating nurses can increase their QWL. Furthermore, it can be concluded from this study that hospital and healthcare center managers can improve the QWL and create a fairer work environment and away from discrimination in the operating room by enhancing the self-efficacy level of nurses and further respecting the professional nursing values, ultimately leading to improved productivity of the healthcare center.

Based on the results of this study, Structural Equation Modeling, unlike the correlation test, was initially able to demonstrate that an increase in perceived organizational justice by participating nurses can lead to an improvement in their quality of work life. Additionally, it can be concluded from this study that hospital and healthcare center managers can enhance the quality of work life and create a more equitable and non-discriminatory work environment in operating rooms by improving the nurses' self-efficacy and further respecting professional nursing values. Ultimately, these actions can lead to improved productivity within the healthcare facility.

Study Limitations

In the present study, there were some limitations including the lack of attention to the impact of economic and cultural variables on individuals' QWL and conducting the study in an urban area. It is recommended that future research should be conducted in a larger research environment with a larger sample size considering the role of economic and cultural factors.

Quality of Working Life (QWL)

Variance Accounted For (VAF)

Structural Equation Modeling (SEM)

Ethics approval and consent to participate:

This study was approved by the Ethics Committee of Shiraz University of Medical Sciences (Ethics code: IR.SUMS.NUMIMG.REC.1402.025). All participants consented to participate in the study and signed an informed consent form. Participants were informed about the research objectives, voluntary nature of participation, right to withdraw, and confidentiality of their information.

Consent for publication

Not applicable.

Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Competing interests

The authors declare there is no conflict of interest.

Authors' contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SA and ZM. The first draft of the manuscript was written by SA and all authors commented on the manuscript. All authors read and approved the final manuscript.

Funding

This article is extracted from the master's thesis of Sahar Ansari and supported by the Research Deputy of Shiraz University of Medical Sciences (No: 27626).

Acknowledgments:

The authors wish to express their gratitude to all the operating room and anesthesia nurses who participated in the study and made this research possible. The authors would like to thank Shiraz University of Medical Sciences, Shiraz, Iran and also Center for Development of Clinical Research of Nemazee Hospital and Dr. Nasrin Shokrpour for editorial assistance.

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No competing interests reported.

The mediating role of professional values and self-efficacy in the relationship between organizational justice and quality of working life among nurses in southwestern Iran

Status:

Version 1

Abstract

Figures

1. Background

2. Method

2 − 1 Study Design and Participants

2–2 Data Collection Tools

1-2-2- Demographic Characteristics Questionnaire

2-2-2 Organizational Justice Questionnaire

2-2-3 Quality of Working Life Questionnaire

2-2-4 Nurses' Professional Values Questionnaire

5-2-2 Self-Efficacy Questionnaire

3 − 2 Data Analysis

2–4 Ethical Considerations

3. Results

4. Discussion

5. Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1