Factors Predicting the Quality of Care Among Nurses in Tertiary Hospitals in Fiji: A Cross-sectional Study

Authors

  • Elina Waqaitamana Veitamana PhD (Candidate), Faculty of Nursing, Chiang Mai University, Thailand.
  • Kulwadee Abhicharttibutra Faculty of Nursing, Chiang Mai University, Thailand.
  • Orn-Anong Wichaikum Faculty of Nursing, Chiang Mai University, Thailand.
  • Apiradee Nansupawat Faculty of Nursing, Chiang Mai University, Thailand.

DOI:

https://doi.org/10.60099/prijnr.2024.268623

Keywords:

Decision-making, Fiji, Job satisfaction, Nursing, Organizational change, Organizational commitment, Quality of care, Relational coordination

Abstract

Quality of care by nurses is a key factor in determining the success of healthcare delivery around the globe, which is impacted by a shortage of nurses, excessive workloads, and unfavorable working conditions, including in the Republic of Fiji Islands. Using the Quality Health Outcome Model, this descriptive-predictive, cross-sectional study examined the quality of care and its predictors among 744 Fijian registered nurses from three tertiary hospitals. Instruments for data collection were the Demographic Data Sheet, the Quality of Care Scale, the Participation in Decision Making Scale, the Relational Coordination Survey, the Perception of Organizational Change Scale, the Job Satisfaction Scale, and the Organizational Commitment Questionnaire. Descriptive statistics and logistic regression analysis were applied to analyze the data.

This study’s findings are informative and offer a glimmer of hope since 72.58% of participants perceived the overall quality of care as good/excellent, indicating a positive baseline. Two factors, relational coordination and job satisfaction, significantly affected the perception of the quality of care. The study model explained 8.90% of the variance in quality of care, with relational coordination being the strongest predictor. These findings provide a clear path to improvement. A comprehensive model should be developed and tested to better understand the factors predicting Fiji’s quality of care before it can be used to design an effective intervention. Developing nursing skills, improving good communication and work environments, and providing high-quality education and training among nurses can significantly improve the quality of care. In addition, support from the government for appropriate medical equipment, recruitment and retention strategies for nurses, and promotion of standard of care from the Ministry of Health and Medical Services are recommended to enhance the quality of care, further bolstering this hopeful outlook. Further Fijian nursing research is clearly needed on this topic in the future.

References

World Health Organization. Quality of care [Internet]. 2024 [cited 2024 Jun 10]. Available from: https://www.who.int/health-topics/quality-of-care#tab=tab_1

Yanful B, Kirubarajan A, Bhatia D, Mishra S, Allin S, Ruggiero ED. Quality of care in the context of universal health coverage: a scoping review. Health Res Policy Sys. 2023;21(1):21. doi:10.1186/s12961-022-00957-5.

World Health Organization. Quality health services [Internet]. 2020 July 20 [cited 2024 Jun 20]. Available from: https://www.who.int/news-room/fact-sheets/detail/quality-health-services

Ministry of Health and Medical Services. National wellness policy for Fiji [Internet]. 2015 Nov 19 [cited 2024 Jan 28]. Available from: https://www.health.gov.fj/wp-content/uploads/2018/03/National-Wellness-Policy-for-Fiji.pdf.

Stewart L, Usher K. The impact of nursing leadership on patient safety in a developing country. J Clin Nurs. 2010;19(21‐22):3152-60. doi: 10.1111/j.1365-2702.2010.03285.x.

Asante AD, Irava W, Limwattananon S, Hayen A, Martins J, Guinness L, et al. Financing for universal health coverage in small island states: evidence from the Fiji Islands. BMJ Glob Health. 2017;2(2):e000200. doi: 10.1136/bmjgh-2016-000200.

Ruggiero S. Hospitals in chaos as Fiji battles COVID-19 hell [Internet]. 2021 July 30 [cited 2024 May 21]. Available from: https://www.aljazeera.com/news/2021/7/30/patients-turned-away-as-fiji-battles-covid-19-hell

Mitchell PH, Ferketich S, Jennings BM. Quality health outcomes model. American American Academy of Nursing Expert Panel on quality health care. Image J Nurs Sch. 1998;30(1): 43-6. doi: 10.1111/j.1547-5069.1998.tb01234.x.

Donabedian A. The quality of care. How can it be assessed? JAMA. 1988;260(12):1743-8. doi: 10.1001/jama.260.12.1743.

Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987-93. doi:10.1001/jama.288.16.1987.

Karasek RA. Job demands, job decision latitude, and mental strain: implications for job redesign. Adm Sci Q. 1979; 24:285-308. doi: 10.2307/2392498.

Tenza IS, Blignaut AJ, Ellis SM, Coetzee SK. Nurse perceptions of practice environment, quality of care and patient safety across four hospital levels within the public health sector of South Africa. BMC Nurs. 2024;23(1):324. doi: 10.1186/s12912-024-01992-z.

Croskerry P, Norman G. Overconfidence in clinical decision making. Am J Med. 2008;121(5 Suppl):S24-9. doi: 10.1016/j.amjmed.2008.02.001.

Liu C, Bartram T, Casimir G, Leggat SG. The link between participation in management decision-making and quality of patient care as perceived by Chinese doctors. Public Manag Rev. 2014:17(10):1425-43. doi: 10.1080/14719037.2014.930507.

House S, Crandell J, Stucky C, Kitzmiller R, Jones C, Gittell JH. Relational coordination as a predictor of job satisfaction and intent to stay among nurses and physicians in the military health system. Mil Med. 2023;188(1-2):e316-25. doi: 10.1093/milmed/usab464.

Bolton RE, Logan C, Gittell JH. Revisiting relational coordination: a systematic review. J Appl Behav Sci. 2021; 57(8):290-322. doi: 10.1177/002188632199159.

Gittell JH, Fairfield KM, Bierbaum B, Head W, Jackson R, Kelly M, et al. Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: a nine-hospital study of surgical patients. Med Care. 2000; 38(8): 807-19. doi: 10.1097/00005650-200008000-00005.

Pernica, MK. Organizational change and employee trust: the mediating roles of perceived organizational support and organizational justice [dissertation]. [Ottawa]: Carleton University; 2011.

Westerberg K, Pienaar J, Nordin M, Romeo M, Yepes-Baldó M. Organizational change and commitment: effects on well-being, turnover intent and quality of care in Spanish and Swedish eldercare. Econ Ind Democr. 2021; 42(4):899-916. doi: 10.1177/0143831X18815970.

Peng J, Li M, Wang Z, Lin Y. Transformational leadership and employees’ reactions to organizational change: evidence from a meta-analysis. J Appl Behav Sci. 2021;57(3): 369-97. doi: 10.1177/002188632092036621.

Meyer JP, Allen NJ. TCM employee commitment survey academic users guide 2004. The University of Western Ontario, Department of Psychology, London. 2004.

Kvist T, Mäntynen R, Partanen P, Turunen H, Miettinen M, Vehviläinen-Julkunen K. The job satisfaction of Finnish nursing staff: the development of a job satisfaction scale and survey results. Nurs Res Pract. 2012;2012:210509. doi: 10.1155/2012/210509.

Maghsoud F, Rezaei M, Asgarian FS, Rassouli M. Workload and quality of nursing care: the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion by using structural equations modeling approach. BMC Nurs. 2022;21(1):273. doi: 10.1186/s12912-022-01055-1.

Maxwell SE. Sample size and multiple regression analysis. Psychol Methods. 2000;5(4):434–58. doi: 10.1037/ 1082-989x.5.4.434.

Baruch Y, Holtom BC. Survey response rate levels and trends in organizational research. Hum Relat. 2008;61(8):1139–60. doi: 10.1177/0018726708094863.

Aiken LH, Patrician PA. Measuring organizational traits of hospitals: the revised nursing work index. Nurs Res. 2000;49(3):146-53. doi: 10.1097/00006199-200005000-00006.

McHugh MD, Stimpfel AW. Nurse reported quality of care: a measure of hospital quality. Res Nurs Health. 2012;35(6): 566-75. doi:10.1002/nur.21503.

Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Sermeus W; RN4CAST Consortium. Nurses’ reports of working conditions and hospital quality of care in 12 countries in Europe. Int J Nurs Stud. 2013;50(2):143-53. doi: 10.1016/j.ijnurstu.2012.11.009.

Probst TM. Countering the negative effects of job insecurity through participative decision making: lessons from the demand-control model. J Occup Health Psychol. 2005; 10(4):320–9. doi: 10.1037/1076-8998.10.4.320.

Gittell JH. Relational coordination: guidelines for theory, measurement, and analysis. Waltham (MA): Brandeis University; 2011.

Ministry of Health and Medical Services. Annual operation plan 2023-2024 [Internet]. 2023 [cited 2024 Jun 21]. Available from: https://www.health.gov.fj/wp-content/uploads/2023/12/Annual-Operational-Plan-2023- 2024.pdf

Ministry of Health and Medical Services. Nurses job description. 2018 [cited 2024 May 30]. Available from: https://www.health.gov.fj/wp-content/uploads/2018/04/Registered-Nurse-Advert.pdf

The Fiji Times. Minister: 807 nurses resign in 2022 [Internet]. 2023 Feb 16 [cited 2024 May 21]. Available from: https://www.fijitimes.com.fj/minister-807-nurses-resign-in-2022/

International Trade Administration. Healthcare [Internet]. 2024 Jan 23 [cited 2024 Jun 21]. Available from: https://www.trade.gov/country-commercial-guides/fiji-healthcare

Zhou S, Blanchart P, Crucianu M, Ferecatu M. Why is the prediction wrong? Towards underfitting case explanation via meta-classification. Processing of the 2022 IEEE 9th International Conference on Data Science and Advanced Analytics (DSAA); 2022 Oct; Shenzhen, China. arXiv. 2023:2302.09952. doi: 10.1109/DSAA54385.2022.10032332.

Yu Q, Li B. Third-variable effect analysis with multilevel additive models. PLoS One. 2020; 15(10), e0241072. doi: 10.1371/journal.pone.0241072.

IBM. What is underfitting? 2020 [cited 2024 May 30]. Available from: https://www.ibm.com/topics/underfitting

Andersen IA, Kleiven OT, Kyte L, Pettersen MAS. Quality of care and job satisfaction in a Hospital Trust before and after the Coordination Reform in Norway. Nurs Open. 2020;7(6):1707-14. doi: 10.1002/nop2.554.

Nilsen P, Seing I, Ericsson C, Birken SA, Schildmeijer K. Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses. BMC Health Serv Res. 2020; 20:147. doi: 10.1186/s12913-020-4999-8.

Zin TP, Abhicharttibutra K, Wichaikum O. Factors predicting quality of nursing care among registered nurses in Myanmar: a cross-sectional study. Pacific Rim Int J Nurs Res. 2024;28(3):496-508. doi: 10.60099/prijnr.2024.266967.

Downloads

Published

2024-08-31

How to Cite

1.
Veitamana EW, Abhicharttibutra K, Wichaikum O-A, Nansupawat A. Factors Predicting the Quality of Care Among Nurses in Tertiary Hospitals in Fiji: A Cross-sectional Study. PRIJNR [Internet]. 2024 Aug. 31 [cited 2024 Nov. 21];28(4):720-32. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/268623