Introduction
Holistic nursing care competency is the effective utilization of knowledge, professional skill, and ethical principles; the continuous development of the profession; and developing strong teamwork with other professionals by understanding the patient’s needs in the area of treatment approach [1, 2]. The holistic nursing care competence tool, developed in Turkey and Japan, consists of five domains with seven Likert scales, focusing on staff education, ethical practice, general aptitude, nursing care team, and professional development [3, 4].
The provision of holistic nursing care competence among nurses has great power for applying inclusive and quality nursing care services for clients [5]. However, the American Holistic Nurses Association report indicated that 55% of holistic nursing care systems have major problems, and 50% stated that the holistic nursing care system’s strategic policies need fundamental change [6].
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Holistic nursing care, addressing patients’ physical, emotional, social, and spiritual needs, is crucial for comprehensive healthcare delivery in Ethiopia, but challenges persist, requiring further research to improve nursing competencies [7].
Lack of holistic nursing care interventions in developing countries, particularly Ethiopia, leads to increased mental illness, physical disability, and social health distractions, resulting in high mortality rates [8, 9].
At the current time, the Ethiopian Ministry of Health transformation agenda states that the quality nursing care service auditable tool is one of the evaluation criteria of Ethiopian health institutions to improve quality health care services, but under this auditable tool, staff education and management, ethically oriented practice, general aptitude, nursing care in the team, and professional development domains of holistic nursing care competence are not considered as criteria of evaluation in the nursing professional aspect [10]. The published research showed that job satisfaction, self-efficacy, passing an exit exam, retrieval of newly published information related to holistic nursing care competence, taking exit exams, and training have a strong association with holistic nursing care competence [11‐13]. So, research on holistic nursing care competence is crucial for improving patient outcomes, workforce well-being, and strengthening the healthcare system, ensuring nursing evolves with societal and healthcare needs.
In Ethiopia, no study has been conducted regarding holistic nursing care competence and associated factors by using linear regression model analysis. Due to this reason, in this study, making it different from the studies, it was intended to study holistic nursing care competence and associated factors with linear regression model analysis concerning education and management, ethically oriented practice, general aptitude, nursing care in teams, and professional development domains of holistic nursing care competence separately to get appropriate information. Therefore, this study aims to assess holistic nursing care competence and identify factors associated with holistic nursing care competence among nurses working in the government hospitals of the South Wollo Zone, Northeast Ethiopia.
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Methods and materials
Study area and period
This study was conducted in the South Wollo Zone Government Hospitals which is found far from Addis Abeba at a distance of 401 km. It was bordered on the south by North Shewa and the Oromia Region, on the west by East Gojjam, on the northwest by South Gondar, on the north by North Wollo, on the northeast by the Afar Region, and the east by the Oromia Zone and the Argobba Special Woreda. In South Woll Zone there are 14 hospitals and has 908 nursing health professionals. The study was conducted from April 15 to May 30, 2022.
Study design
Institution-based cross-sectional study design was conducted.
Participants
The source population were all nurses working in Government Hospitals of South Wollo Zone, while the study population were all nurses working in selected Government Hospitals of in South Wollo Zone during the study period. Furthermore, the sample population were all nurses randomly selected during the data collection period in the selected Government Hospitals.
Eligible criteria
All nurses were working in Government Hospitals of South Wollo Zone during the data collection period.
Exclusion criteria
Nurses who were unable to complete self-administered questionnaires due to maternity leave, sick leave and critical illness during the data collection period.
Sample size determination and sampling technique
Previously, no study was conducted in Ethiopia regarding holistic nursing care competence and its associated factors. For this reason, the first step was to determine the variance of the sample size by conducting a pretest in Mersa Primary Hospital on 25 nurses. Then, the sample size was determined using a single mean formula by taking the 95% confidence level, Z α/2 = 1.96, n = sample size, and E = maximum error of estimation, which was used = 1–5 units. The total sample size formula was calculated as follows concerning each domain of holistic nursing care competence: n = (Za/2) ^2*S^2/E^2, whereas S = sample variance. Staff education and management n=(1.96)2*(8.5)2/(1)2 = 278, ethical-oriented practice, n=(1.96)2*(9.5)2/(1)2 = 347, general aptitude, n=(1.96)2*(7.5)2/(1)2 = 216, nursing care in a team, n=(1.96)2*(5.5)2/(1)2 = 117, and professional development, n=(1.96)2*(10.5)2/(1)2 = 424. Then, considering the largest sample size among the five domains of holistic nursing care competence, professional development was taken, n = 424, and a 5% non-response rate of 424* 5/100 = 22; therefore, the total sample size is 446.
Selecting seven Government hospitals from out of fourteen Government hospitals by using a random lottery method. Then, using the proportional allocation formula (PAS), the total sample size for each Government hospital was calculated by the total number of nurses for each hospital multiplied by the total sample size determined by using a single mean formula divided by the total number of nurses in seven Government hospitals, n = Nf x nt/Nt. Lastly, by using human resource nurses’ profiles as sampling frame, simple random sampling method was applied to select each participant from each hospital. (Fig. 1).
Fig. 1
The schematic presentation of sampling procedure to calculate total sample size for each Public Hospital of South Wollo Zone, 2022. n = Total sample size of each hospital. Nf = total number of nurses in each hospital. nt = total sample size calculated by using a single mean formula. N grand = total number of nurses in seven hospitals
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Variables
Dependent variable
Holistic nursing care competence.
Independent variables
Socio-demographic characteristics
age, gender, marital status, educational status, average monthly salary in Ethiopian Birr, and employment status.
Work-related factors
Types of health facilities, the position of nurses, previous training, frequency of training, having guidelines/manuals, working experiences, and workload.
Personal factors
retrieval of newly published information related to holistic nursing care, taking exit exam, job satisfaction, interest in the nursing profession, and self-efficacy.
Operational definitions
Holistic nursing care competence
The nurses are to be assessed by the holistic nursing competence scale, which contains 36 items consisting of five domains: general aptitude (7 items), staff education and management (9 items), ethical-oriented practice (9 items), nursing care in the team (7 items), and professional development (4 items). Each item was scored from 1 to 7 on a response scale, which was agreed upon as a seven-point Likert scale. To calculate each domain score by adding each total number of items under each domain and translating each domain score 0-100 linearly, the higher the mean score of each domain, the higher the mean score of holistic nursing care competence [3, 4].
Low self-efficacy
An individual responded below the mean score, and
High self-efficacy
An individual responded greater than or equal to the mean score [14].
Poor job satisfaction
An individual responded below the mean score, and.
Good job satisfaction
An individual responded greater than or equal to the mean score [12].
Data collection tools and procedures
The first part of the questionnaire contains socio-demographic data, which was developed from the literature review. The second part of the questionnaire was to measure holistic nursing care competence, which was adopted from Turkey’s and Japan’s holistic nursing care competence scale validated tools. This measuring tool had five domains with a total sum of 36 items and seven Likert scales that were ordered from 1 to 7 response scores [3, 4]. The third part of the questionnaire contained work-related factors and personal-related factors that were developed from the literature review. Among these job satisfaction and general self-efficacy tools, those were validated in Ethiopia and the United Kingdom, respectively [12, 14]. The four BSc nurses and five public health officers were assigned from different health centers in different woredas out of the study areas. Among these health professionals, seven were assigned as data collectors, and two public health officers were assigned as supervisors. The data collection was implemented through a structured, self-administered questionnaire.
Data quality assurance
All questionnaires were checked appropriately and written in English language versions without spelling, punctuation, or grammatical errors carefully before starting actual data collection, and the questionnaire order was kept from simple to difficult. Data collectors and supervisors were given training for a one-day duration to collect appropriate data from the study participants. A pretest was done on 10% of the population a week before the actual data collection period at Woldia Comprehensive Specialized Hospital. During the pretest, the internal consistency of the holistic nursing care competence scale was assessed by computing Cronbach’s alpha, which was 0.85. In addition to this, validity was done by experts to check the cultural consistency, coherence, and understanding of the participants’ thoroughly. After this, some modifications were made, such as the correction of typing errors, the reorientation of data collectors, and the arrangement of questionnaires. Then, at the end of each data collection day, the questionnaires were checked by supervisors for completeness, and the supervisors discussed with the data collectors.
Data processing and analysis
Data were coded, cleaned, and explored to identify outliers, missing values, and inconsistencies. The coded data were checked for completeness and entered into Epidata V4.6.0.2 and exported to SPSS Version 27 for analysis. Recoding was done on self-efficacy and job satisfaction, and then the mean score of each domain was obtained by computing the sum of each item that was found under each domain before doing descriptive statistics. For analysis, dummy variables (for k categories, k-1 dummy variable) were created for categorical variables such as educational status, marital status, occupational status, types of health facilities, the position of nurses, frequency of training, and working experiences. In the descriptive analysis, the mean, standard deviation, frequency, and percentages were calculated and kept by using tables. All linear assumptions, like homogeneity of variances, normality, Multicollinearity, and linearity, were checked in all domains.
A simple linear regression analysis was done for one dependent variable and one predictor variable for each independent variable. They were transferred to multivariable linear regression analysis at a p-value < 0.2 with a 95% confidence interval. Lastly, multivariable linear regression analysis was done by using the enter method, and variables whose p-value was less than 0.05 at a 95% confidence interval with an unstandardized B-coefficient of the predictor variables were declared to have a relationship between the dependent variable and independent variables in the model.
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Results
Socio-demographic characteristics of the study participants
Out of 446 study participants, 430 participated in the study, which gave a response rate of 96%. Among the total respondents, 224 (52%) were male, and regarding educational status, 323 (75%) graduated with a first degree, whereas 17 (4%) graduated with a master’s in nursing. Of the total respondents, 264 (62%) were married, and 21 (5%) respondents were divorced. Regarding employment status among the total respondents, 321 (75%) were formal employees, and 16 (4%) were novices. The mean age of the respondent was 30 (SD ± 4.5), and the mean average monthly salary of the respondent was 6950 (SD ± 1410) in Ethiopian birr (Table 1).
Table 1
Socio-demographic characteristics of holistic nursing care competence among study participants working in Government hospitals of South Wollo Zone, Northeast Ethiopia, from April 15 to May 30 /2022 (n = 430)
Types of variables | Category | Frequency (N) | Percentage (%) |
|---|---|---|---|
Gender | Male | 224 | 52% |
Female | 206 | 48% | |
Total | 430 | 100% | |
Educational status | Diploma | 90 | 21% |
Degree | 323 | 75% | |
Master | 17 | 4% | |
Total | 430 | 100% | |
Marital status | Single | 117 | 27% |
Married | 264 | 62% | |
Widowed | 28 | 6% | |
Divorced | 21 | 5% | |
Total | 430 | 100% | |
Employment status | Novice | 16 | 4% |
Short term contractors | 23 | 5% | |
Long term contractors | 70 | 16% | |
Formal employee | 321 | 75% | |
Total | 430 | 100% | |
Age (MEAN ± SD) in years | 430 | 30 ± 4.5 | |
Average monthly salary in Ethiopian birr (Mean ± SD) | 430 | 6950 ± 1410 |
Work-related factors of the study participants
Of the total respondents, 177 (41%) were working in comprehensive specialized hospitals, and 105 (25%) were working in primary hospitals. Regarding the position of nurses, 337 (78%) were assigned to staff nurses, whereas 38 (9%) were assigned to hospital directors. Among the total respondents, 298 (69%) had not taken training related to holistic nursing care competence. The median frequency of training related to holistic nursing care competence of the respondents was two, and 321 (75%) of respondents confirmed having no holistic nursing care competence guideline in the hospitals. Among the total respondents, 252 (59%) had a workload in the hospitals, and the median working experience of the respondents in the hospitals was five years (Table 2).
Table 2
Work related factors of holistic nursing care competence among nurses working in Government hospitals of South Wollo Zone, Northeast Ethiopia, from April 15 to May 30 /2022 (n = 430)
Types of variables | Category | Frequency (N) | Percentage (%) |
|---|---|---|---|
Types of health facilities | Primary Hospitals | 105 | 25% |
General Hospitals | 148 | 34% | |
Comprehensive specialized hospital | 177 | 41% | |
Total | 430 | 100% | |
Position of Nurses | Directors | 38 | 9% |
Staff Nurses | 337 | 78% | |
Head Nurses | 55 | 13% | |
Total | 430 | 100% | |
Training related to holistic nursing care competence | No | 298 | 69% |
Yes | 132 | 31% | |
Total | 430 | 100% | |
Frequency of training (Median with 50th IQR) | 139 | 2 | |
Holistic nursing guidelines/manuals | No | 321 | 75% |
Yes | 109 | 25% | |
Total | 430 | 100% | |
Workload | No | 178 | 41% |
Yes | 252 | 59% | |
Total | 430 | 100% | |
Working experiences (Median with 50th IQR) in years | 430 | 5 |
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Personal-related factors of the study participants
Among the total respondents, 219 (51%) did not retrieve newly published information from articles and guidelines related to holistic nursing care competence, and 259 (60%) respondents took the certificate competency exam. Among 259 respondents who took the certificate competency exam, 245 (57%) passed the certificate competency exam. Regarding the self-efficacy of nurses, 250 (58%) had high self-efficacy, and regarding the job satisfaction of nurses, 249 (58%) had good job satisfaction. Of the total respondents, 261 (61%) had a nursing professional interest (Table 3).
Table 3
Personal related factors of holistic nursing care competence among nurses working in Government hospitals of South Wollo Zone, Northeast Ethiopia, from April 15 to May 30 /2022 (n = 430)
Types of variables | Category | Frequency (N) | Percentage (%) |
|---|---|---|---|
Retrieval of new published information related to holistic nursing care competence | No | 219 | 51% |
Yes | 211 | 49% | |
Total | 430 | 100% | |
Take Certificate Competency exam | No | 171 | 40% |
Yes | 259 | 60% | |
Total | 430 | 100% | |
Passed Certificate Competency exam | No | 14 | 3% |
Yes | 245 | 57% | |
Total | 259 | 60% | |
Self-efficacy of nurses | High Self-efficacy | 250 | 58% |
Low Self-efficacy | 180 | 42% | |
Total | 430 | 100% | |
Job satisfaction of nurses | Good job satisfaction | 249 | 58% |
Poor job satisfaction | 181 | 42% | |
Total | 430 | 100% | |
Professional interest of nurses | No | 169 | 39% |
Yes | 261 | 61% |
Holistic nursing care competence five domains
The staff education and management, ethically oriented practice, general aptitude, nursing care in team and professional development domains of holistic nursing care competence mean scores were 3.8 ± 1.3 (3.7–3.9), 4 ± 1.4 (3.9–4.2), 4.2 ± 1.3 (4-4.3),4 ± 1.4 (3.8-4), and 3.9 ± 1.5 (3.7-4), respectively (Table 4).
Table 4
The five domains of holistic nursing care competence with their mean score of study participants working in Government hospitals of South Wollo Zone, Northeast Ethiopia, from April 15 to May 30 /2022 (n = 430)
Types of domain | Mean | Median | Minimum Score | Maximum score | SD | 95%CI | |
|---|---|---|---|---|---|---|---|
Lower Bound | Upper Bound | ||||||
Staff education and management | 3.8 | 3.8 | 1 | 6.9 | 1.3 | 3.7 | 3.9 |
Ethical oriented practice | 4 | 4 | 1 | 7 | 1.4 | 3.9 | 4.2 |
General aptitude | 4.2 | 4 | 1 | 7 | 1.3 | 4 | 4.3 |
Nursing care in team | 4 | 4 | 1 | 7 | 1.4 | 3.8 | 4 |
Professional development | 3.9 | 4 | 1 | 7 | 1.5 | 3.7 | 4 |
Factors associated with staff education and management domain of holistic nursing care competence
Variables that had a p-value less than 0.2 that transferred from simple linear regression to multivariable linear regression were age, average monthly income, number of training, working experience, diploma in nursing, degree in nursing, single, widowed, novice, primary hospital, general hospital, having no training, having a workload, and having no retrieval published information from articles and d guidelines, have not taken the Certificate Competency exam, Have no nursing professional interest, low self-efficacy, being female and poor job satisfaction. Among these variables entered in multivariable linear regression their p-value less than 0.05 were being female and nurses who have poor job satisfaction had positive and negative relationship respectively with staff education and management domain of holistic nursing care competence.
Being female was on average 0.5 times more likely to increase staff education and management domain of holistic nursing care competence as compared to being male by keeping the effect of other variables constant [0.5, 95% CI (0.030 to 0.897)].
Nurses who have poor job satisfaction were on average 0.57 times lower in the staff education and management domain of holistic nursing care competence as compared with those nurses who have good job satisfaction by keeping the effect of other variables constant [-0.57, 95% CI (-1.1 to -0.02)] (Table 5 ).
Table 5
Multivariable linear regression analysis on factors associated with staff education and management domain of holistic nursing care competence in study participants working in Government hospitals of South Wollo Zone, Northeast Ethiopia, from April 15 to May 30 /2022 (n = 430)
Variables | Unstandardized coefficients | Standardized coefficients | p-value | 95% CI for B | ||
|---|---|---|---|---|---|---|
Beta | Std.Error | Beta | Lower Bound | Upper Bound | ||
Constant | 4.965 | 1.289 | 0.000 | 2.413 | 7.518 | |
Female | 0.5 | 0.219 | 0.185 | 0.036 | 0.030 | 0.897 |
Male | Reference | Reference | Reference | Reference | Reference | |
Poor job statsfication | -0.566 | 0.276 | -0.211 | 0.042 | -1.112 | -0.02 |
Good job statsfication | Reference | Reference | Reference | Reference | Reference | |
Factors associated with ethical-oriented practice domain of holistic nursing care competence
Variables that had a p-value less than 0.2 that transferred from simple linear regression to multivariable linear regression were age, average monthly income, number of training, working experience, diploma in nursing, degree in nursing, single, widowed, novice, primary hospital, general hospital, having no training, having a workload, and having no retrieval published information from articles and d guidelines, have not taken the Certificate Competency exam, Have no nursing professional interest, low self-efficacy, being female and poor job satisfaction. Among these variables entered in multivariable linear regression, their p-value less than 0.05 was being female and nurses who have poor job satisfaction had positive and negative relationships respectively with ethical-oriented practice domain of holistic nursing care competence.
Being female was on average 0.58 times more likely to increase the ethical-oriented practice domain of holistic nursing care competence as compared to being male, keeping the effect of other variables constant [0.58, 95% CI (0.09 to 1.06)].
Nurses who have poor job satisfaction were on average 0.76 times lower in the ethical-oriented practice domain of holistic nursing care competence as compared with those nurses who have good job satisfaction, keeping the effect of other variables constant [-0.76, 95% CI (-1.4 to -0.2)] (Table 6).
Table 6
Multivariable linear regression analysis on factors associated with ethical oriented practice domain of holistic nursing care competence in study participants working in Government hospitals of South Wollo Zone, Northeast Ethiopia, from April 15 to May 30 2022 (n = 430)
Variables | Unstandardized Coefficients | Standardized Coefficients | P-value | 95.0% Confidence Interval for B | ||
|---|---|---|---|---|---|---|
B | Std. Error | Beta | Lower Bound | Upper Bound | ||
Constant | 3.224 | 1.412 | 0.024 | 0.428 | 6.020 | |
Female | 0.575 | 0.245 | 0.212 | 0.020 | 0.091 | 1.060 |
Male | Reference | Reference | Reference | Reference | Reference | |
Poor job satisfaction | -0.755 | 0.304 | -0.259 | 0.014 | -1.356 | -0.153 |
Good job satisfaction | Reference | Reference | Reference | Reference | Reference | |
Factors associated with the general aptitude domain of holistic nursing care competence
Variables that had a p-value less than 0.2 that transferred from simple linear regression to multivariable linear regression were Age, average monthly income, number of training, working experience, female, diploma, degree, single, widowed, divorced, primary hospital, general hospital, have no taken training, have no guideline, having workload, have no retrieve information from published articles and guidelines, have no taken Certificate of Competency exam, have no nursing professional interest, low self-efficacy and poor job satisfaction. Among these variables entered in multivariable linear regression, their p-value less than 0.05 was the number of training, being single and primary hospitals had a positive relationship with general aptitude domain of holistic nursing care competence.
As the number of training increased in one frequency, nurses’ general aptitude domain of holistic nursing care competence increased by 0.22, keeping the effect of other variables constant [0.22, 95% CI (0.03 to 0.42)]
Being single was on average 0.54 times more likely to increase the nurses’ general aptitude domain of holistic nursing care competence as compared to being married, keeping the effect of other variables constant [0.54, 95% CI (0.013 to 1.06)].
Nurses who are working in primary hospitals were on average 0.62 times more likely to increase the nurses’ general aptitude domain of holistic nursing care competence as compared with those nurses who are working in comprehensive specialized hospitals, keeping the effect of other variables constant [0.62, 95% CI (0.023 to 1.21)] (Table 7).
Table 7
Multivariable linear regression analysis on factors associated with general aptitude domain of holistic nursing care competence in study participants working in Government hospitals of South Wollo Zone, Northeast Ethiopia, from April 15 to May 30, 2022 (n = 430)
Variables | Unstandardized Coefficients | Standardized Coefficients | P-value | 95.0% Confidence Interval for B | ||
|---|---|---|---|---|---|---|
B | Std. Error | Beta | Lower Bound | Upper Bound | ||
Constant | 3.232 | 1.262 | 0.012 | 0.732 | 5.732 | |
How many times you have taken the trainings | 0.224 | 0.099 | 0.201 | 0.025 | 0.029 | 0.419 |
Single | 0.535 | 0.264 | 0.177 | 0.045 | 0.013 | 1.057 |
Married | Reference | Reference | Reference | Reference | Reference | |
Primary hospital | 0.618 | 0.300 | 0.221 | 0.042 | 0.023 | 1.212 |
Comphernsive Specialized Hospital | Reference | Reference | Reference | Reference | Reference | |
Factors associated with nursing care in the team domain of holistic nursing care competence
Variables that had a p-value less than 0.2 that transferred from simple linear regression to multivariable linear regression were Age, average monthly income, number of training, working experience, female, diploma, degree, single, widowed, divorced, primary hospital, general hospital, have no taken training, have no guideline, having workload, have no retrieve information from published articles and guidelines, have no taken Certificate of Competency exam, have no nursing professional interest, low self-efficacy and poor job satisfaction. Among these variables entered in multivariable linear regression, their p-values less than 0.05 were being female, being single, having a workload, having poor job satisfaction and having low self-efficacy had positive and negative relationships respectively with nursing care in the team domain of holistic nursing care competence.
Being female was on average 0.53 times more likely to increase the nurses’ nursing care in the team domain of holistic nursing care competence as compared to being male, keeping the effect of other variables constant [0.53, 95% CI (0.28 to 0.77)].
Being single was on average 0.37 times more likely to increase the nurses’ nursing care in the team domain of holistic nursing care competence as compared to being single, keeping the effect of other variables constant [0.37, 95% CI (0.08 to 0.67)].
Having a workload was on average 0.2 times more likely to increase the nurses’ nursing care in the team domain of holistic nursing care competence as compared to having no workload, keeping the effect of other variables constant [0.2, 95% CI (0.04 to 0.34)].
Nurses who have poor job satisfaction were on average 0.8 times lower in the nurses’ nursing care team domain of holistic nursing care competence as compared with those nurses who have good job satisfaction, keeping the effect of other variables constant [-0.8, 95% CI (-1.04 to -0.48)].
Nurses who are developing low self-efficacy were on average 0.4 times lower in the nurses’ nursing care in the team domain of holistic nursing care competence as compared with those nurses who have high self-efficacy, keeping the effect of other variables constant [-0.4, 95% CI (-0.67 to -0.12)], (Table 8)
Table 8
Multivariable linear regression analysis on factors associated with nursing care in team domain of holistic nursing care competence in study participants working in Government hospitals of South Wollo Zone, Northeast Ethiopia, from April 15 to May 30/ 2022 (n = 430)
Variables | Unstandardized Coefficients | Standardized Coefficients | P-value | 95.0% Confidence Interval for B | ||
|---|---|---|---|---|---|---|
B | Std. Error | Beta | Lower Bound | Upper Bound | ||
(Constant) | 4.306 | 0.568 | 0.000 | 3.189 | 5.423 | |
Female | 0.525 | 0.122 | 0.185 | 0.0001 | 0.284 | 0.765 |
Male | Reference | Reference | Reference | Reference | Reference | |
Single | 0.372 | 0.150 | 0.117 | 0.014 | 0.077 | 0.666 |
Married | Reference | Reference | Reference | Reference | Reference | |
Have workload | 0.190 | 0.077 | 0.132 | 0.014 | 0.039 | 0.340 |
Have no workload | Reference | Reference | Reference | Reference | Reference | |
Low self-efficacy | -0.395 | 0.142 | -0.137 | 0.006 | -0.674 | -0.117 |
High self-efficacy | Reference | Reference | Reference | Reference | Reference | |
Poor job satisfaction | -0.760 | 0.143 | -0.264 | < 0.0001 | -1.041 | -0.479 |
Good job satisfaction | Reference | Reference | Reference | Reference | Reference | |
Factors associated with the professional development domain of holistic nursing care competence
Variables that had a p-value less than 0.2 that transferred from simple linear regression to multivariable linear regression were Age, average monthly income, number of training, working experience, female, diploma, degree, single, widowed, divorced, primary hospital, general hospital, have no taken training, have no guideline, having workload, have no retrieve information from published articles and guidelines, have no taken Certificate of Competency exam, have no nursing professional interest, Staff, low self-efficacy and poor job satisfaction. Among these variables entered in multivariable linear regression, their p-values less than 0.05 were being female, being a staff, age, having poor job satisfaction and having low self-efficacy had positive and inversely relationships respectively with the professional development domain of holistic nursing care competence.
Keeping the influence of other variables constant, being female was on average 0.34 times more likely than being male to boost the professional development domain of holistic nursing care competence [0.34, 95% CI (0.08 to 0.6)].
Keeping the influence of other variables constant, being a staff was on average 0.2 times more likely to boost the nurses’ professional development domain of holistic nursing care competence than being a director [0.2, 95% CI (0.05 to 0.35)].
As age increase in one year, nurses professional development domain of holistic nursing care competence decrease by 0.045 factor keeping effect of other variables were constant[ -0.045, 95% CI (-0.086 to -0.005)].
Keeping the influence of other variables constant, nurses with low job satisfaction scored 0.76 times worse on average than nurses with high job satisfaction in the holistic nursing care competency professional development domain [-0.76, 95% CI (-1.06 to -0.45)]
Keeping the influence of other variables constant, nurses with low self-efficacy were on average 0.52 times less competent in the holistic nursing care domain of professional development than nurses with high self-efficacy [-0.52, 95% CI (-0.82 to -0.21)](Table 9).
Table 9
Multivariable linear regression analysis on factors associated with professional development domain of holistic nursing care competence in study participants working in Government hospitals of South Wollo Zone, Northeast Ethiopia, from April 15 to May 30/ 2022 (n = 430)
Variables | Unstandardized Coefficients | Standardized Coefficients | P-value | 95.0% Confidence Interval for B | ||
|---|---|---|---|---|---|---|
B | Std. Error | Beta | Lower Bound | Upper Bound | ||
Constant | 4.882 | 0.813 | 0.000 | 3.284 | 6.479 | |
Age | -0.045 | 0.021 | -0.134 | 0.029 | -0.086 | -0.005 |
Female | 0.341 | 0.134 | 0.112 | 0.011 | 0.077 | 0.605 |
Male | Reference | Reference | Reference | Reference | Reference | |
Staff | 0.201 | 0.078 | 0.109 | 0.011 | 0.047 | 0.354 |
Director | Reference | Reference | Reference | Reference | Reference | |
Low self-efficacy | -0.515 | 0.153 | -0.167 | 0.001 | -0.817 | -0.213 |
High selfeficacy | Reference | Reference | Reference | Reference | Reference | |
Poor job satisfaction | -0.758 | 0.155 | -0.246 | < 0.0001 | -1.063 | -0.454 |
Good job satisfaction | Reference | Reference | Reference | Reference | Reference | |
Discussion
Holistic nursing care is important to care in the clinical setup. Therefore, this study was done to assess the holistic nursing care competency of nurses and its associated factors. This study revealed that the holistic nursing care competency’s mean score for the management and staff education domains was 3.8 (3.7–3.9). This study implied that there is a need for improved management and staff education in holistic nursing care competence, which requires the efforts of responsible bodies. This study was aligned with a study conducted with a mean score of 3.65 in Japan [4]. However, this study was lower than the study conducted in Turkey with a mean score of 4.8 [3]. This difference might be due to the sample size, educational status and year of clinical experience.
The mean score of the ethical-oriented practice domain of holistic nursing care competency was 4 (3.9–4.2). The findings of this study indicated that the nursing universal ethical principle guideline’s applicability was challenged by nurse professionals in hospitals. Therefore, the hospital administrative bodies should follow the implementation of the nurse ethical guideline in the clinical area during patient care. The finding of this study were higher than studies conducted at the Mettu University of Ethiopia and the Oromia Regional State of Ethiopia, with mean scores of 2.4 and 2.34, respectively [11, 13]. But, it was lower than studies conducted in Turkey and Japan, with mean scores of 5.42 and 4.7, respectively [3, 4]. This difference in various studies might be because of the target population, study area, clinical setting up, inclusion criteria and exclusion. On the contrary, this study was higher than a study conducted in Iran, with a mean score of 3 [15]. The difference might be due to geographical variations, years of experience, and educational status.
The mean score of the professional development domain of holistic nursing care competency was 3.9 (3.7–4). The implication of this finding might be the opportunity for continuous professional development utilization by nurses was undermined in hospitals so that the hospital administrators’ bodies should forecast their effort priorities on nurses’ professional development issues. The findings of this study were higher than the studies conducted at the Mettu University of Ethiopia and the Oromia Regional State of Ethiopia with a mean score of 2.3 and 2, respectively [11, 13]. Furthermore, this study’s mean score was higher than that of a study conducted in Iran with a mean score of 2.9 [15]. This difference might be due to the target population and the fact that this study area included additionally comprehensive specialized hospitals and geographical variations. Similarly, this study’s mean score was consistent with the mean score of a study conducted in Japan 3.77 [4]. On the contrary, the mean score of this study was lower than that of a study conducted in Turkey, with a mean score of 5.2 [3]. This discrepancy might be due to study area, educational status, geographical variations, and tool variations.
The mean score of nursing care in the team domain of holistic nursing care competency was 4 (3.8–4). The finding of this study implied that the team-working habitat might be in the hospital was compromised. Therefore, the responsible bodies in the hospital should be focused on empowering teamwork by creating a harmonious working environment. This study finding was higher than studies conducted at the Mettu University of Ethiopia and the Oromia Regional State of Ethiopia, with a mean score of 2 and 1.97 respectively [11, 13]. The discrepancy might be due to in this study, an additional comprehensive specialized hospital was included, the majority of study participants in this study were males and their educational status was degree. Similarly, the mean score of this study finding was higher than the study conducted in Iran, with a mean score of 2.8 [15]. This difference might be due to geographical area and tool variations. On the contrary, this study’s mean score was lower than that of studies conducted in Turkey and Japan, with mean scores of 5.2 and 4.54 respectively [3, 4]. This discrepancy might be due to study area, educational status, geographical variations, and tool variations.
The mean score of the general aptitude domain of holistic nursing care competency was 4 (3.8–4). This study’s mean score was lower than studies conducted in Turkey and Japan, with mean scores of 5.6 and 5.3, respectively [3, 4]. This discrepancy might be due to study area variations, educational status, geographical variations, and tool variations. On the contrary, this study’s mean score was higher than that of a study conducted in Iran, with a mean score of 2.7 [15]. This difference might be due to the geographical area, the sample size in this study being larger than Iran, and the fact that this study included additionally comprehensive specialized hospitals. The study revealed a low nursing general aptitude, requiring regular training among nurses on holistic nursing care competence guidelines to enhance decision-making capacity of nurses based on scientific evidence by hospital administrators and other stakeholders.
Being female was strongly associated with staff education and management, ethical-oriented practice, nursing care in team, and professional development domains of holistic nursing care competence as compared with being male. The study suggests that female nurses may act as mothers in patient care, highlighting the need for better utilization of female nurses as role models for other healthcare providers. This study’s finding was consistent with a study conducted in public hospitals of Wolaita Zone, South Ethiopia [16].
Nurses who have poor job satisfaction significantly had lower staff education and management, ethical-oriented practice, nursing care in team, and professional development domains of holistic nursing care competence as compared with nurses who have good job satisfaction. This study finding implied that there was a potential imbalance between professional career growth and staff motivation, highlighting the need for improved organizational environment, learning opportunities, and collaboration in healthcare by hospital administrators and other responsible bodies. This study finding was consistent with the study conducted in public hospitals of Wolaita Zone, South Ethiopia [16].
An increase in the frequency of training for nurses had a direct relationship with the general aptitude domain of holistic nursing care competence. This study finding implied that the responsible bodies forecasting capacity-building training for nurse professionals in the hospitals. The finding of this study was strongly supported by a study conducted in public hospitals of Wolaita Zone, South Ethiopia [16].
Being single was positively associated with the general aptitude and nursing care in the team domains of holistic nursing care competence as compared with being married. This study’s finding might be that nurses who are living alone are decreasing family burdens, reducing stress, having enough time to read different guidelines, and increasing motivation to collaborate. This finding was in line with two studies conducted in public hospitals in Iran [15, 17].
Nurses who are working in primary hospitals had a positive relationship with the general aptitude domain of holistic nursing care competence as compared with nurses who are working in specialized hospitals. This study finding might be due to the nurses who are working in primary hospitals having fewer patients and having more time to explore updated information.
Nurses who have a heavy workload are more likely to increase their nursing care in the team domain of holistic nursing care competence as compared with nurses who do not have a heavy workload in hospitals. The finding of this study might be that when increasing the cases, there was a greater chance of getting complicated cases, and the collaboration care in hospitals was increasing.
Nurses who have low self-efficacy are negatively associated with nursing care in the team domain and the professional development of holistic nursing care competence as compared with nurses who have high self-efficacy. This study’s finding might indicate that nurses have great problems in the affective domain, psychomotor domain, and cognitive domain of competence because the nurse’s professional impairment in these domains lacks motivation to ward team care building and professional development through different learning approaches.
Being a staff member was positively associated with the professional development domain of holistic nursing care competence as compared to being a director. This might be the staff nurses are spending more time on professional-related job responsibilities than leadership and management-related work. Due to this fact, staff nurses are more competent in professional development through any approach to learning. This study finding was contradicted by a study conducted in the Ilu AbaBor Zone, Oromia regional state of Ethiopia [13]. The difference might be in this study finding the director most of the time spent in the administrative area as comparable to study conducted in the Ilu AbaBor Zone, Oromia regional state of Ethiopia.
Age had inversely relationship with professional development domain of holistic nursing care competence. This might be when the age of the nurses increasing the learning motivation decrease and the capacity of explorer the new information might be decreasing.
Conclusion and recommendation
Staff education and management, ethical-oriented practice, general aptitude, nursing care in the team, and professional development domains of holistic nursing care competence mean scores were recorded low.
Being female was positively associated with staff education and management, ethical-oriented practice, nursing care in team, and professional development domains of holistic nursing care competence, whereas poor job satisfaction was negatively associated with staff education and management, ethical-oriented practice, nursing care in team, and professional development domains of holistic nursing care competence.
The increase in training, being single and in a primary hospital, had a positive relationship with the general aptitude domain of holistic nursing care competence.
Being single and having a heavy workload had a positive relationship with nursing care in the team domain of holistic nursing care competence, whereas low self-efficacy had a negative relationship with professional development and nursing care in the team domains of holistic nursing care competence, and being a staff member was positively associated with the professional development domain of holistic nursing care competence, whereas age had inversely relationship with professional development domain of holistic nursing care competence.
Health policymakers
The policymakers should motivate nurses to participate in staff education and management, general aptitude or problem-understanding capacity, nursing care in the team, continuous professional development capacity, and ethical-oriented practice in the clinical area.
Hospital managers
The hospital administrators should utilize female nurses as role model for the care of the patient in holistic nursing care competency approach. The hospital managers should give attention nurses who assigned in managerial level to empower their academic potential in addition to administrative parts as like as staff nurses. The hospital administrators empowering teamwork in the clinical area to reduce nursing workload. The hospital administrators should assign more nurses those hospitals who have high patient follows to get nurses more time the explorer of more information about their professions as like as the primary hospital nurses. The hospital managers should increase frequency of training for the strengthening of holistic nursing care competence in the clinical area. The hospital managers should develop strategies like staff motivation, retention, a harmonious working environment, and rewards to enhance the job satisfaction and self-efficacy of nurses in the clinical area.
For health professionals
The nurses should follow a holistic approach to empower their profession concerning staff education and management, general aptitude, nursing care in the team, professional development, and ethical-oriented practice domains of holistic nursing care competence in the clinical area.
Nurse professionals should respect their profession, read different nursing theories, comply with holistic nursing care guidelines, and enhance collaborative care with other health professionals to develop their job satisfaction and self-efficacy.
For researchers
Researchers should better do this by using a mixed approach regarding holistic nursing care competence.
For the community
The community should have a positive attitude towards the nursing profession to empower the holistic nursing care competencies in the clinical area.
Limitations of the study
It cannot establish causality or temporal relationships between dependent and predictor variables. This model of analysis always depends on assumptions like linearity, normality, and multicollinearity, and it is exposed to sampling bias and social desirability bias. Also, this study was only conducted by quantitative cross-sectional study design, as a result reducing the ability to get the depth of information.
Acknowledgements
First, we would like to express our gratitude to Wollo University College of Medicine and Health Sciences for giving us a chance to prepare this research. Lastly, gratitude went to South Wollo Zone Public Hospitals staffs and managers for their cooperation in giving information that supported the development of this research. And also, we would say thank you about the data collectors for collecting the valuable data for this study.
Declarations
Ethics approval and consent to participate
The study was approved by Wollo University Ethical Committee Ethical Review Board. All study participants were told that participation was completely voluntary, that written informed consent was obtained, and that they could withdraw from the study at any if they were not comfortable with the questionnaire. A participant’s privacy and confidentiality were ensured by not including a personal identifier. All methods were performed in accordance with the Declaration of Helsinki.
Consent for publication
Not Applicable.
Competing interests
The authors declare no competing interests.
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