Journal of Perioperative & Critical Intensive Care Nursing
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Comparing Self-esteem and Job Motivation of Nurses and Surgical Technologists of teaching hospitals in 2020

Fariba asadi^{* *}Correspondence: Fariba asadi, Department of Nursing, University of Bandar Abbas, Bandar Abbas, Iran, Tel: 9355435603, Email:

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Introduction

Human resource is the most important asset of any organization [1] and is always emphasized by experts in Human Resource Management (HRM) [2]. The higher the quality of this asset, the greater the probability of the organization’s success, survival, and promotion would be [1]. Paying attention to human resources in health organizations is doubly important [3] and plays a crucial role in adjustment and development of care and treatment [2]. Self-esteem is among the personality traits that affects an organization’s human resource behaviors in the workplace [3]. Self-esteem is the awareness and attitude that a person constantly has towards their values and is the most important determining factor in human behavior [4]. This is among the effective factors in the psychological development of individuals and has significant effects on personality traits and activities [5]. If the need for self-esteem is not satisfied, broader needs such as the need to progress and understand remains limited, and symptoms such as depression, anorexia nervosa, anxiety, violence, belligerent behaviors, and psychosocial withdrawal manifest [6].

Nurses and other healthcare professionals whose primary responsibility is to care for patients have needs that should be addressed, one of which is self-esteem [5-6]. Nurses with high self- esteem provide medical care with better quality to patients [3], while nurses with low self-esteem easily react negatively in the face of failures, negative events, and psychosocial risk factors such as high working pressure, lack of support, patients’ death and mourning of their families, and working in high-stress wards in connection with patients with chronic diseases and cancer [7]. Results of Sheny et al.’s study indicated a correlation between moderate to low levels of self- esteem and moderate to high levels of burnout among nurses [8].

Motivation is another behavioral trait that was coined in 1930 and includes all the areas that are somehow related to human behavior [9]. Motivation is defined as the source of human movement, initiator, guide, and maintainer of behavior until the desired goal is achieved [9]. It explains the desire of employees to overcome workplace challenges and adapt to changing working conditions [10]. According to the studies, nurses can achieve high job motivation by gaining a positive professional identity in the light of receiving respect and value, appropriate organizational structure, adequate income, benefits, and job facilities, and decent social status [11].

Job motivation of different people in an organization may not be the same. Salary and benefits, enthusiasm in the workplace, job security, being interested in the job, better social interactions in the workplace, job nature, spirit of appreciation, and job attractiveness are among the factors affecting job motivation. Job motivation is not separate from developmental, social, and physiological needs, but these needs should be met. The reason for everyone to advance a job is to have a stimulus, and every organization needs motivated force to achieve its goals. If individuals do not have enough job motivation, they are not able to meet their needs in this field, leading to a decrease in their efficiency [11].

Understanding the motivational factors of employees and consequently improving their performance have long been among the most important concerns of human resource managers, because job motivation can help achieve more efficient results, create a positive work environment, and successfully implement the planned programs. Results of a study on job motivation indicated 20% of the success of organizations was related to the employees’ efforts and 80% was due to their job motivation [12]. Health sector is among the most important areas of sustainable development in human societies due to its direct relationship with human health, which requires highly motivated medical staff [11]. In nursing organizations, rapid decision- making in unpredictable and high-risk situations, lack of control, limited organizational framework, and critically ill patients are among the conditions that, if there is not sufficient motivation, can quickly lead to fatigue, increased errors, service abandonment, and reduction of nursing service quality [11]. In their study, Nasiri Ziba, et al. determined job motivation of surgical technologists in educational hospitals affiliated to Iran University of Medical Sciences and showed the mean score of job motivation was 3.33 ± 0.52 (out of 4), suggesting moderate to high levels of job motivation among the surgical technologists.[12] Surgical nurse is among the key jobs in healthcare settings that is responsible for providing high-quality services to clients. Increasing job satisfaction can also improve the quality of services received by patients and enhance patient satisfaction with health services [12]. The sensitivity of this job is quite obvious for various reasons such as the stress of the patient’s anesthesia and their vulnerability. Unfortunately, surgical nurses sometimes complain about surgeon’s rude behavior and their impaired self-esteem.

Objective

Considering the importance of self-esteem and job motivation, especially in healthcare settings, the present study aims to compare self-esteem and job motivation of nurses and surgical technologists in educational-medical hospitals, Birjand, Iran. By identifying the priorities, the necessary plans should be made to increase self-esteem and job motivation of the staff in these two areas of treatment.

Methods

Study design and participants

This descriptive-analytical study was conducted in 2020. The statistical population included all the nurses and surgical technologists in educational hospitals, Birjand. The sample size was obtained as 75 individuals per group considering 90% power, 10% probability of withdrawal, 5% error and using this formula:

The participants were selected using multistage sampling method. The nurses and surgical technologists in each hospital were selected proportionally and examined by convenience method. Inclusion criteria were willingness to participate in the study, having at least one year of work experience, and having at least an Associate’s degree in nursing or surgical technology. Exclusion criterion was unwillingness to participate in the study.

Study instruments

Data collection instruments included a demographic information checklist, Coopersmith Self-Esteem Inventory (CSEI), and Ludahel Kitchener’s job motivation questionnaire.

Coopersmith self-esteem inventory consists of 58 items describing a person’s feelings, beliefs, and reactions, and the subjects should respond to these items by choosing either “like me (Yes)” or “not like me (No)” options. The number of items in each subscale is as follows: 26 items in general scale, 8 items in social scale, 8 items in family scale, 8 items in education/job scale, and 8 items in lie detector scale. The subscale scores as well as overall score provide the context in which people have a positive self-image. Coopersmith self-esteem inventory had acceptable validity confirmed in several studies. Based on Iranian normalization, the reliability of this scale was reported to be 0.73 [16]. The scoring method is as 0 and 1. The 8 items included to detect lie are excluded in calculating the total score. If the respondent scores more than 4, it means that the test validity is low and the subject has tried to show themselves better than they are. Regarding the scoring of other items, if the subject responds to items 1,4,5,8,9, 14,19,20,27,28,29,33,37,38,39,42,43,46, and 47 with Yes, they get 1 score, and if they respond to these items with No, they get 0 score. The rest of the items are reversed. The minimum and maximum scores are 0 and 50, respectively. The score of 26 or less indicate low self-esteem, scores between 23 and 27 represent moderate self-esteem, and the score of 44 or higher indicate high self-esteem. In general, a higher score suggests higher selfesteem in each subscale. The 20-item job motivation questionnaire was introduced by Ludahel Kitchener. This questionnaire measures the characteristics of job seriousness, job satisfaction, job interest, job importance, responsibility, selfconfidence, and self-control. Items 1, 5, 6, 7, 11, 12, 13, 15, and 17 are related to the person’s interest in the job, items 2, 10, 14, 18, and 19 are related to job importance, items 3 and 4 describe job satisfaction, items 8 and 9 manifest self-confidence, and item 16 and 20 are related to responsibility and self-control, respectively. The job motivation questionnaire is based on a 4- point Likert scale, ranging from strongly disagree (1) to strongly agree (4), so that a higher score indicates higher job motivation. The mean score was used to determine job motivation in this study. Scores of 1-1.99 indicated low job motivation, scores of 2-2.99 represented moderate job motivation, and scores of 3 and above indicated high job motivation. In Akhondi Bonab et al.’s study, its validity was confirmed and the reliability of the questionnaire was reported with Cronbach’s alpha of 0.88 [17]. In this study, the reliability of the questionnaire was obtained as 0.79.

Ethical considerations

This study was approved as a student project with ethics code of IR.BUMS.REC.1399.147. The objectives and benefits of the study were explained to the participants and they were ensured that their data would be kept confidential and they could withdraw.

Data analysis

The data were entered into SPSS 22.0 software and analyzed using descriptive statistics (central tendency and dispersion) and inferential statistics (independent t-test and ANOVA).

RESULTS

This study was conducted on 146 individuals, 75 of whom were nurses and 71 were surgical technologists. The mean age of the participants was 30.91 ± 8.05 years old and their mean work experience was 8.71 ± 5.88 years (Table1). Also, 74.3% of the participants were female and 78.5% were married. The majority of the participants (88.3%) had a Bachelor’s degree.

Table 1: Frequency distribution of participants’ demographic characteristics.

In this study, the mean self-esteem scores of nurses and surgical technologists were 34.84 ± 6.81 and 37.18 ± 7.13, respectively. As presented in Table 2, the self-esteem of the majority of the participants in both groups was at the moderate level. In the nurse group, 12% of the participants had low self-esteem and 8% had high self-esteem, while in the surgical technologist group, 5.6% and 18.3% had low and high self-esteem, respectively.

Table 2: Frequency distribution of self-esteem levels in the studied groups.

The mean scores of job motivation were 49.56 ± 6.14 and 48.26 ± 5.28 in the nurse and surgical technologist groups, respectively. Table 3 indicates 90.4% of the nurses and 95.8% of the surgical technologists had moderate job motivation and no significant difference was observed between the two groups.

Table 3: Frequency distribution of job motivation levels in the studied groups.

Kolmogorov-Smirnov test showed both job motivation and selfesteem were normal (p>0.05). Therefore, independent t-test was used to compare the mean scores of self-esteem and job motivation in the two groups. The results indicated a significant difference between the nurses’ and surgical technologists’ selfesteem. As shown in Table 4, surgical technologists’ self-esteem was higher than that of nurses. However, there was no significant difference between the two groups in terms of job motivation (p>0.05).

Table 4: Comparing self-esteem and job motivation in nurse and surgical technologist groups.

Discussion

Results of this study revealed the mean self-esteem scores of nurses and surgical technologists were 34.84 and 37.18, respectively. However, Sheini Jaberi et al. reported the mean selfesteem score of nurses as 81.91 ± 28.74, which was higher than that in the present study [6]. Given that the research population was dedicated to a specific group of nurses working in the burn unit, emergency ward, and ICU and there was a difference in the type of questionnaire, the difference in the results was not unexpected.

The results indicated the self-esteem of the majority of the participants in both groups was at the moderate level; however, according to the obtained mean total score, surgical technologist’s self- esteem was significantly higher than that of nurses, the reason for which could be attributed to difference in their job nature. Considering that in the studies conducted on self-esteem, the surgical technologists have not been examined alone and, in some studies, sampling was performed from surgical nurses and nurses working in other words, it was impossible to accurately compare the results. Hence, further studies are recommended to be performed in this regard.

Consistent with the present study, Dabirian et al. (2014) reported the majority of the nurses had moderate self-esteem.[3] Results of Saadati’s and Karanikola’s studies showed the nurses had moderate to low levels of self-esteem.[15,16] Uys et al. demonstrated the nurses had high self- esteem, which was not in line with the present study [17].

Inconsistencies between the results indicated self-esteem and self-concept levels differ depending on the time period and socioeconomic status in different situations and cultures.[18] Self-esteem can be influenced by many intrinsic and extrinsic factors such as educational environment and friends. Also, family plays a fundamental role in the formation of self-esteem. People with high self-esteem are more resilient to life’s problems and have more perseverance, and as a result, are more likely to succeed. Therefore, self-esteem can indirectly have a significant impact on people’s progress and success. Also, another reason for low self-esteem could be that people are not given necessary job training to improve their self-esteem. Thus, managers should consider the required training programs in this field.

The results indicated the mean score of job motivation in both groups was at the moderate level and no significant difference was observed between the two groups in this regard. However, Nasiri Ziba et al. studied job motivation of surgical technologists and found that their job motivation was higher than the moderate level.[13] which was consistent with the studies of Mahmoudi et al. and Jabbari, et al., [19,20] Therefore, intrinsic motivational factors such as different job nature and job position could be influential [13]. Judet et al. (2013) evaluated the overall score of nurses’ job motivation as moderate [21]. Kamensi (2011) showed the nurses in educational hospitals had moderate level of job motivation [22]. The mean job motivation levels of nurses were 3.83 in a hospital in Portugal in 2015 [23] and 3.50 in a public hospital in Cyprus in 2010 [24].

However, it is impossible to judge conclusively based on the figures reported for nurses’ job motivation in different regions and situations. The obtained mean values provide the possibility of making initial judgments on nurses’ job motivation. Accordingly, the studies were in line with the present work. The nurses’ job motivation in Kashan psychiatric hospital was assessed as lower than the moderate level, which was inconsistent with the present study [25]. The reason for this difference could be attributed to the point that the participants in this study were selected from a psychiatric hospital, while the nurses selected in the present study were working in educational hospitals. Therefore, when assessing job motivation, differences between departments and type of hospital should be considered. The conditions and facilities of wards play an important role in the nurses’ motivation. Attitude towards one’s workplace, support, and emotional fatigue are also among the effective factors [25].

In general, a review study conducted in Iran reported the mean job motivation of nurses has increased by about 0.24%, indicating the measures taken in recent years such as various strategies of the health system transformation plan, quality improvement, effectiveness, accreditation, strategic planning, etc. have been somewhat effective in the nurses’ motivation and have probably led to an increase in the independence, responsibility, and motivation of nurses [26].

Ayyash et al. reported the nurses working in Gaza hospitals had high motivation [27] and Taghavi Larijani showed the nurses working in internal surgery wards in Tehran had low motivation [28], both of which were inconsistent with the present study. These discrepancies between the results can probably be attributed to different methods and tools in the research. Also, according to the studies, nurses’ job motivation is affected by individual and organizational factors [29]. Moreover, Hosseini et al. found that there was a direct and positive correlation between the two components of teamwork and job motivation, so that the more the teamwork is done, the higher the job motivation will be. Therefore, considering that the surgical technologists work in groups with other Surgicalstaff and surgeons, they are expected to have more job enthusiasm and motivation [7].

Motivation is an intrinsic state that motivates a person to do a particular activity. Comparing the nurses’ and surgical technologists’ job motivation revealed that what is considered motivation for people in a specific group may not be important to a person in the other group; in other words, the person and the field in which they work are among the most important factors affecting the motivational forces.

People’s personality, independence, and autonomy as well as being in different situations are considered as characteristics affecting job motivation. Moreover, nurses’ capabilities, job involvement and ability to do teamwork, salary and financial benefits, promotion status, potential rewards, supportive relationships, and interactions are considered as factors influencing nurses’ job motivation.[30] Results of another study in Tanzania showed a clear job description was an important motivational factor for both management and performance. Clarifying roles and responsibilities as well as the appropriateness of tasks with the nursing profession were also reported as major motivational factors for healthcare staff [31].

Emotional and psychological conditions of nurses while completing the questionnaires were among the limitations of this study that could affect their response, and this variable was beyond the control of the researchers. Also, the questionnaires were completed in a self-reporting manner, so the accuracy of our judgments was based on confidence in them. To control this factor, the researchers tried to convince the participants to cooperate sincerely by explaining the objectives of the research. Considering that family performance, work environment, psychological status, etc. that may affect self-esteem and job motivation concepts were not examined in this study, it is recommended for future studies to investigate the educational and psychological factors influencing the mentioned variables. Given that the limited number of studies has been performed on surgical technologists, considering these staff was among the strengths of the study. This variable could affect the main variables of research, so the researchers are recommended to include this factor in their studies.

Conclusion

Since nurses and Surgicaltechnologists who have higher selfesteem and job motivation, provide better quality medical care to patients, so action to improve their self-esteem and job motivation, especially in nurses, by Managers of the health system seem very necessary.

Acknowledgements

We would like to thank from Research department of the Birjand University of Medical Science, nurses, and surgical technologists for their sincere cooperation in this study.

Financial Support and Sponsorship

This study was financially supported by Birjand University of Medical Science.

Conflicts of Interest

There are no conflicts of interest.