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Compassionate care; Factors; Motivational; Public hospitals; South Wollo

AOR: Adjusted Odds Ratio; CI: Confidence Interval; HCP: Health Care Providers; HWF: Health Work Force; MCC: Motivational Competent and Compassionate; NSHFs: North Shewa Zone Health Care Facilities; TOT: Training of Trainers

Motivation is the degree to which an individual is willing to work towards achieving a personal goal that is in line with the organization's goals and the factors that may or may not drive behavior [1].

Compassion is a strong desire to lessen another person's suffering and/or sensitivity to another person's pain or feeling. Empathy, sympathy and kindness are the capacity to care for others just a few of the values that are connected to compassion [2]. In the healthcare organization the idea of compassionate care practice is frequently used. It has been promoted as a fundamental component of nursing practice and could be considered nursing's most valuable asset [3].

Understanding the motivational scores, figuring out what motivates nurses and how managers and leaders can successfully motivate the nurses are issues that are of growing concern [4,5]. In order to establish an encouraging environment and a feeling of intimacy among nurses, patients and families compassionate patient care are crucial for nurses [6].

The challenges in the healthcare system, particularly in the public hospitals, revolve around in the practice of motivational and compassionate care. The motivation of nurse professionals working in the health institution have an impact on the delivery of health care services. Low morale among workers had a negative impact on service quality and can turn off potential employees.

An institutional based study conducted in public hospitals of West Amhara, Ethiopia revealed that the overall motivation score among health workers was 58.6%. In this finding, sociodemographic factors: Sex, age, professional status, type of hospital and length of services and institutional factors like performance management system, staffing and work schedule, staff development opportunities, provision of necessary materials, communication and training were predictors motivational and compassionate care practices. Another study in north Shewa zone, Ethiopia showed that 61.2% nurses had good compassionate care practice. Sex, age, monthly income and attitude were significantly assocated with compassionate care practice.

The health care system faces challenges, especially at public health facilities, with respect to compassionate patient care. Nursing's concept of compassionate care is "engaging into a patient's experience and enabling them to retain their independence and dignity". It is considered to be an essential tenet of patient-centred care and describes how care is delivered through relationships based on compassion, respect and dignity.

Globally, there are many challenges in the practice of motivational and compassionate care practice, particularlly in public hospitals. However, there is no study about motivational and compassionate care practice in Ethiopia, specifically in South Wollo Zone. Thus, this study was aimed to assess motivational, compassionate care practice and associated factors among nurses working in south Wollo zone public hospitals.

Study area and period

The study was conducted in South Wollo Zone public hospitals from April to May, 2023. South Wollo Zone is one of the thirteen zones that are found in the Amhara region which is found far from Addis Ababa at a distance of 401 km and from Bahir Dar at a distance of 471 km. It is 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 Afar Region and on the east by the Oromia Zone and the Argobba Special Woreda. It has seventeen woredas with a total population of 2,518,862 and also has 499 health posts, 126 health centers and 14 hospitals. It has a total of 900 health extension workers in rural areas and urban areas 150 health extension workers. In general, there are 908 nurses in fourteen hospitals.

Study design

An institutional based cross-sectional study was conducted.

Population

All nurses working in South Wollo Zone public hospitals were source population whereas all nurses who were present during the study period were study population.

Eligibility criteria

All nurses who were working during the data collection period were included while nurses who were on leave and providing free services were excluded from the study.

Sample size determination

Sample size was determined using objectives. For the first objective, sample size was determined by using a single population proportion formula through taking 48.0% proportion of health care professionals provided good compassionate care at Addis Ababa hospital, 95% CI and 5% margin of error.

Where; n=the required sample size P=proportion of nurses a=level of confidence z=degree of accuracy at 95% d=margin of error

After adding 10% non-response rate, the final sample size was 421.

Sample size for the second objective was calculated using Epi info version 7.

The sample size calculation for the first objective (sample size calculation using single population proportion) was greater than the second objective (Motivational and compassionate care practice). Thus, the sample calculated by the first objective was taken as the final sample size which was 421.

Sampling procedure and technique

Among fourteen hospitals, seven hospitals were selected by using lottery method. First, the total numbers of nurses were obtained from human resource office from each hospital. From seven hospitals, there are a total of 551 nurses then proportional allocation for each hospital was allocated. Study participants were selected by using simple random sampling technique (Figure 1).

 

Figure 1: Schematic presentation of sampling procedure for associated factors of motivational and compassionate care practice among nurses working in south Wollo zone public hospitals Dessie, Ethiopia, from April 1 to 30, 2023.

Study variables

Dependent variables

• Motivational care practice
• Compassionate care practice

Independent variables

• Socio demographic characteristics (Age, gender, marital status, educational status, remuneration, work experience and monthly income).
• Organization factors (Development career/growth, leadership, job satisfaction, recognition and work ethics, work life balance, presence of training opportunities).
• Personal system of values and belief (Personal interest and positive role models of compassion)
• Behavioral factors (Professional factors, attitude and level of education)

Operational definitions

Good motivational care: Participants who were scored equal to or greater than the mean of motivational care items.

Poor motivational care: Participants who score below the mean of motivational care items.

Good compassionate care: Participants who was score equal to or greater the mean of compassionate care items.

Poor compassionate care: Participant who scored below the mean of compassionate care items.

Favorable attitude: Participants who scored equal to or above the mean of attitude items.

Unfavorable attitude: Participants who scored less than the mean of attitude items.

Data collection tools/instruments

The data were collected by using structured self-administered questionnaire adapted from development and psychometric properties of a compassionate care questionnaire for nurses and Ethiopian National Compassionate Respectful Care (CRC) participants training manual. The tool had five parts: Part I: Socio-demographic characterstics, part II professional attitude, part III organizational factors, part IV motivational care practice and part V compassionate care practice.

The outcome of motivational and compassionate care practice was measured using a five-point Likert scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree and 5=strongly agree for motivational care with 19 items) and (1=never, 2=rarely, 3=sometimes, 4=often and 5=always for compassionate care with 27 items).

Data quality control

Data were collected by six public health officers and three general practitioners as supervisor. Training was given for data collecters and supervisors on the objective of the study and how to collect relevant data from each participant. Pre-test (5%) was done at Woldia comprehensive specialized hospital to check whether the questionnaires were simple, clear and easily understandable. Continuous supervision was done on daily basis on the completeness of the collected data and necessary adjustment was given on time.

Data processing and analysis

The collected data were entered to Epidata version 4.6.1 and exported to SPSS version 26 for further analysis. Descriptive statistics such as texts, frequency distribution tables and pie charts were used to compute and present the relevant variables. Binary logistic regression, odds ratio along with 95% CI were applied. To identify statistically significant factors, bivariable analysis was conducted and variables with p-value less than 0.25 were candidated to multivariable analysis. Those variables having a p-value less than 0.05 in multivariable analysis declared as statistically significant. Model fitness was checked by Hosmer and Lemeshow’s test (0.194, 0.756) for motivational and compassionate care practice respectively).

Socio-demographic characteristics

Out of 421 participants,409 were involved in the study with response rate of 97.15%. Two hundred thirty-six (57.7%) were females and 270 (66.0%) had bachelor degree in nursing. Two hundred seventy-eight (68%) had more than ten years of working experience and 194 (47.4%) were earned monthly salary of 6170-8017 Ethiopian birr.

Professional attitude

After computing the items of professional attitude, the mean was calculated. This mean was used to categorize professional attitude as favorable and unfaborable. Accordingly, 233 (56.97%) of the participant had unfavorable attitude and 176(43.03%) had favorable attitude towards motivational and compassionate care practice.

Organizational factors

From organizational measuring items, more than half of the participants responded that they had no concern on motivational and compassionate care practice.

Motivational care practice

The motivational care practice items were computed and mean (± standard deviation) was calculated (35.41 ± 6.46). These mean was used to categorize participants as good and poor motivational care practice. Those participants who scored mean and above the mean considered as having good motivational care practice whereas those scored less than the mean considered as having poor motivational care practice. Accordingly, 176 (43%) had good motivational care practice and 233 (57%) had poor motivational care practice.

Factors associated with motivational care practice

To see the association between motivational care practice and explanatory variables, bivariable and multivariable binary logistic regression was carried out. Variables having P-value<0.25 were candidated into the multivariable logistic regression analysis to come up with final predictors of motivational care practice. Being male was 1.6 times more likely to have good motivational care practice as compared to females (AOR=1.622, 95% CI: 1.074-2.448). Presence of acknowledgment among nurse was 1.59 times more likely to have good motivational care practice as compared to counter parts (AOR=1.586, 95% CI: 1.038-2.424) and being focal person was 39% less likely to have good motivational care practice as compared to its counterpart (AOR=0.61 95% CI: 0.401-0.912) were predictors for motivational care practice.

Compassionate care practice

After computing the items of compassionate care practice items, mean was calculating and the (mean ± SD) was 61.99 ± 13.75. This mean value was used to classify participants into two categories. Those participants who scored greater than or equal to the mean value were considered as having good compassionate care practice while those scored less than the mean value were considered as having poor compassionate care practice. Accordingly, 194 (47.4%) had good compassionate care practice and 215 (52.6%) had poor compassionate care practice.

Factors associated with compassionate care practice

First bivariable logistic analysis was performed to see the association between compassionate care practice and explanatory variables. Variables having p-value<0.25 in bivariable analysis were candidated to multivariable binary logistic regression. From multivariable binary logistic regression, variables having p-value<0.05 along with 95% CI declared as statically significant. Being male was 1.64 times more likely to have good compassionate care practice as compared to females (AOR=1.64, 95% CI: 1.070-2.497). Participants working in general hospital were 2.64 times more likely to have good compassionate care practice as compared to those participants who were working in primary hospitals (AOR=2.636 (95% CI: 1.153-6.025). Likewise, participants working in comprehensive specialized hospitals were 4.27 times more likely to have good compassionate care practice as compared to those participants who were working in primary hospitals (AOR=4.270 (95% CI: 2.006-9.090). Participants having no training access were 44% less likely to have good compassionate care practice as compared to participants who had training access (AOR=0.564, 95% CI: 0.374-0.851).

Motivational care practice

There are many challenges in the practice of motivational compassionate care practice, particularly in public hospitals. The finding of this study was aimed to assess motivational and compassionate care practice among nurses who had worked in South Wollo zone public hospitals. In this study the magnitude of good motivational care practice was 43.03% (95% CI: 38.4, 47.9). This finding was higher than the study conducted in Gideon zone governmental hospitals (19.5%). But lower than the study conducted in West Amara governmental hospitals in North West Ethiopia (58.6%). This may be due to difference in sample size, study area, study period and facility structure.

Being male was 1.6 times more likely to have good motivational care practice as compared to females (AOR=1.622, 95% CI: 1.074-2.448). This study was supported by the previous study. Presence of acknowledgment among nurse was 1.59 times more likely to have good motivational care practice as compared to counter parts (AOR=1.586, 95% CI: 1.038-2.424). this finding is consistent with the study conducted in west Amhara. Being focal person was 39% less likely to have good motivational care practice as compared to its counterpart (AOR=0.61 95% CI: 0.401-0.912). This result is indicated that nurses who were focal person in hospitals might get updated information and trainings concerning motivational care and more exposed for the practice of motivational care for patients.

Compassionate care practice

In this study, the practice of compassionate care was (47.4%, 95% CI: 42.5-52.3). This finding is in line with studies done in Addis Ababa public hospitals (48%) and South Gondar zone public hospitals (50.7%). However, this finding is higher than study conducted in North Shewa Zone, Ethiopia (38%). The differences might to be due to sample size study period and study design.

Sex was associated with compassionate care practice. Being male was 1.64 times more likely to have good compassionate care practice as compared to females (AOR=1.64, 95% CI: 1.070-2.497). This study was supported by the previous study conducted in Spain.

Working facility was predictor for compassionate care practice. Nurses working in general hospital were 2.64 times more likely to have good compassionate care practice as compared to those participants who were working in primary hospitals (AOR=2.636 (95% CI: 1.153-6.025). Likewise, participants working in comprehensive specialized hospitals were 4.27 times more likely to have good compassionate care practice as compared to those participants who were working in primary hospitals (AOR=4.270 (95% CI: 2.006-9.090). this might be due to high probability of being trained and updated with the latest guideline as well as having senior health professionals with different disciplines.

Training was a predictor for compassionate care practice. Nurses who had no training access for compassionate care practice were 44% less likely to have good compassionate care practice as compared to participants who had training access (AOR=0.564, 95% CI: 0.374-0.851). This might be due to the fact that training is the tool that improve nurse’s knowledge, attitude and practice of the nursing care implementation. Having this nurses that had gotten training about compassionate care practice had good compassionate care implementation for the patients.

The magnitude of motivational and compassionate care practice among nurses in this study area were below half. Being male, being focal person and acknowledgment were predictors of motivational care practice whereas being male, working facility and training access were predictors of compassionate care practice. We recommended that hospitals provide training to nurses on motivational and compassionate care practice. Moreover, we recommended that researchers conduct this study by supporting qualitative studies.

As the study was new in this study area as well as in Ethiopia there is scarcity of adequate literatures. Thus, comparing with abroad studies is not sounded well.

An ethical letter was obtained from tropical college of medicine Ethical Review Committee (ERC) and a letter of permission was obtained from the chief executive officers of the study hospitals. The objective of the study was clearly explained to the study participants. To ensure confidentiality, data were collected anonymously and all data collection was done in accordance with the Helsinki Declaration.

Not applicable.

The data used for the study are available from the corresponding author at any time.

Not applicable.

The authors declare that they have no competing interests.

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted and agree to be accountable for all aspects of the work.

We would like to thank data collectors, supervisors and the study participants for their valuable contribution to the study.

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