Profiling and measurement of work passion in South African nurses
Rabie, Gerhard Hendrik
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Nurses are seen as forming the backbone of the South African healthcare system and are regarded as playing an important role in achieving government's goal of a healthy life for all South Africans. However, research has suggested that some nurses end up in nursing for reasons other than having a passion for the profession. Passion for work has scientifically been linked with both positive and negative consequences for the wellbeing and performance of employees at work. If nurses are therefore not passionate about their profession, this may have a negative impact on the clinical practice environments where they operate. The effective management of the passion of employees in the workplace has been suggested to counter the negative impact thereof and to reap the benefits that passionate employees bring to the workplace. Unfortunately, research on work passion has focused mainly on Westernised countries and a literature search revealed no such research within the South African nursing context. The idea of this research project was therefore to introduce work passion research to the field of nursing in South Africa. This entailed an exploration of what nursing passion entails and an investigation into scientific measures that can be used to measure nursing passion The general objective (purpose) of this research project was therefore to draft a profile of professional nurses in terms of the passion they show towards nursing and to investigate ways of measuring this passion for the purpose of managing it effectively in future. This will benefit nurses themselves, their patients, clinical practice environments and ultimately the nursing profession as a whole. In order to achieve the general objective (purpose) of this research project, three studies were conducted, which are reported on in three research articles in this thesis. Each of these had their own general objective (purpose) and specific objectives. The general objective (purpose) of study 1 was to explore nursing passion within the South African context and to test an instrument (the passion scale) for the measurement thereof. This study followed a parallel mixed-method design. The expectation was that a combination of qualitative and quantitative data would provide a clearer understanding of the passion construct and the measurement of passion within the nursing context. The quantitative part of the study used a cross-sectional design and included a combined sample of 163 registered professional and student nurses to test the passion scale for use within the South African context. In line with the use of the scale in other countries, the exploratory factor analysis revealed a two-factor structure for the scale and Cronbach alphas higher than .70 for both Harmonious Passion (.85) and Obsessive Passion (.81). Partial correlations between Harmonious Passion and the Passion-definition Criteria while controlling for Obsessive Passion revealed some correlation. Partial correlations between Obsessive Passion and Passion-definition Criteria while controlling for Harmonious Passion revealed no correlation. Convergent validity was therefore not confirmed. Except for the latter, the scale operated similarly than in other countries and further investigation into its psychometric properties was recommended. The qualitative part of study 1 followed a constructivist approach. Semi-structured interviews were held with a combined sample of 16 professionally registered and student nurses. Thematic analysis was used to analyse the data, while a phenomenological strategy was used to interpret the data. Findings revealed four main themes with their respective subthemes: (1) passion-definition criteria (love/like nursing, valuing nursing, time/energy involvement and autonomous internalisation), job investment (role model, change agent, empowering others, going the extra mile and life-long learning), compassion (empathy, caring and helping people and holistic care), and personal characteristics (competent and confident, commitment, resilience, interpersonal skills and leadership skills). Based on the findings, the nursing passion construct was conceptualised. The general objective (purpose) of study 2 was to compare the psychometric properties of the subscales of an original and contextualised version of the passion scale using Rasch analysis; and an investigation into the impact of adding a frame-of-reference to the contextualised scale. A quantitative approach with a cross-sectional design was used to reach the purpose of the study. A sample of 447 professionally registered and student nurses was included in the study. Rasch analysis was used to analyse the data. The results revealed disordered thresholds for all the subscales being analysed; in terms of item location and item fit, the harmonious subscales revealed fit to the Rasch model, while the obsessive scales did not initially show fit. In terms of targeting, all the scales revealed that participants were adequately separated by the items. Some items of the original harmonious passion subscale and modified adapted subscale violated the Rasch assumption of local independence. Uniform differential item functioning for ethnicity was found for all four subscales, while non-uniform differential item functioning was only found for the modified adapted obsessive passion subscale. A comparison of the subscales in terms of their operating characteristics revealed multi-dimensionality indicative that the two passion scales measured something slightly different after the frame-of-reference was added to the items. The findings of this study revealed that the items of the passion scale need further investigation and that the addition of a frame-of-reference improved the operating characteristics of the adapted passion scale over that of the original scale. The general objective (purpose) of study 3 was to report on the development and psychometric properties of the nursing passion indicator scale. The steps of DeVellis (2012) were followed in the development of the scale. Items development were based on the qualitative data obtained in study 1. Items were developed for the main themes: job investment, compassion and personal characteristics to measure their respective subthemes. Items were not developed for the passion-definition criteria, as it was to be measured with the passion scale. This study followed a quantitative approach and a cross-sectional design. Data collection for study 2 and 3 was done simultaneously and therefore the 108-item nursing passion indicator scale was administered to the same sample (447) of nurses as was described in study 2. A separate exploratory factor analysis was conducted on each of the three main themes (now called scales) mentioned above. A five-factor structure was revealed for job investment with Cronbach alphas ranging between .80 and .88 and a Cronbach alpha of .91 for the total job investment scale. A three-factor structure for compassion was revealed with Cronbach alphas ranging between .79 and .88, and a Cronbach alpha of .88 for the total compassion scale. A five-factor structure was revealed for personal characteristics with Cronbach alphas ranging between .72 and .89, and a Cronbach alpha of .89 for the total personal characteristic scale. This research project contributed towards the conceptualisation of nursing passion within the South African context. Furthermore, the two-factor structure of the passion scale and high internal consistency thereof confirmed that the scale operated similarly within the South African context than in Westernised countries. However, further analysis of its convergent validity is needed. It was also shown that the addition of a frame-of-reference to the passion scale improved its operating characteristics above that of an original scale. It was, however, indicated that the passion scale items need to be revisited for future use to increase reliability and to eliminate item bias. This study also developed a new scale to identify nursing passion within the nursing context. The scale is to be used in conjunction with a passion scale contextualised to the field of nursing. Together, these two scales will in future contribute to the identification of passion and the management thereof in South African clinical practice environments.
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