How to Assess the Applicability of Integrative Review

  • Journal List
  • Iran J Nurs Midwifery Res
  • v.21(2); Mar-Apr 2016
  • PMC4815364

Islamic republic of iran J Nurs Midwifery Res. 2016 Mar-Apr; 21(2): 107–117.

An integrative review of literature on determinants of nurses' organizational commitment

Seyyed Abolfazl Vagharseyyedin

1Nursing and Midwifery College, Birjand Academy of Medical Sciences, Ayatollah Ghaffari Avenue, Birjand, Iran

Received 2014 May 17; Accustomed 2015 Aug 19.

Abstract

Background:

This integrative review was aimed to examine in literature and integrate the determinants of nurses' organizational delivery in hospital settings.

Materials and Methods:

In this study, an integrative review of the literature was used. The search strategy began with vi electronic databases (e.m. CINAHL and Medline). Considering the inclusion criteria, published studies that examined the factors influencing nurses' organizational delivery in the timeframe of 2000 through 2013 were chosen. Data extraction and assay were completed on all included studies. The final sample for this integrative review comprised 33 studies.

Results:

Based on mutual meanings and central bug, 63 different factors contributing to nurses' organizational delivery were integrated and grouped into iv chief categories: Personal characteristics and traits of nurses, leadership and direction manner and behavior, perception of organizational context, and characteristics of job and work surround.

Conclusions:

In general, categories emerged in this study could be useful for formulating initiatives to stimulate nurses' OC. However, footling is known about the relative significance of each identified gene among nurses working in different countries. Qualitative enquiry is recommended for narrowing this gap. Future research should exist directed to examine the psychometric properties of the organizational scales for nurses in different cultures.

Keywords: Integrative review, nurses, organizational commitment

INTRODUCTION

It is widely agreed that organizational commitment (OC) is an of import determinant of nurse turnover.[1,two] Previous research has suggested a significant positive clan between work outcomes such as performance and productivity, and OC.[3,four]

In full general, OC is variously defined and conceptualized in the literature; even so, in that location are ii perspectives on this concept in full general: Attitudinal and behavioral.[5] The attitudinal perspective focuses on employee's identifying with the organization and his/her desire to maintain the relationship with the arrangement,[6] whereas OC, from a behavioral perspective, describes a person's preoccupation with the organization as evidenced by personal fourth dimension devoted to organizational activities.[7]

According to Zangaro, the almost widely accepted definition of OC is that suggested by Mowday et al.[5] They define information technology equally "the relative strength of an individual's linkage to the organization"; this is further characterized by iii factors which are strong belief in and acceptance of the system'due south goals and values, willingness to exert considerable endeavour on behalf of the organization, and stiff desire to maintain membership in the organization.[8]

It tin can be causeless that factors influencing OC may alter over time. That is considering nurses proceed to feel changes in part and part in the workplace. Carver and Candela emphasize on each generation'southward unique perspective of OC.[9] Information technology is extremely important for nurse managers to understand the influencing factors on the OC of the electric current nursing workforce. Thus, the current review was aimed to assess in literature and integrate the determinants of nurses' OC in hospital settings.

ThousandATERIALS AND METHODS

Study blueprint

In this integrative review, the methodology proposed by Whittemore and Knafl was followed. Since the integrative review method has been critiqued for lack of rigor and its potential for bias, Whittemore and Knafl accept provided a 5-step procedure to heighten the rigor of this method in nursing. According to them, the process of an integrative review includes articulation of the trouble to exist studied, completion of a well-divers literature search, evaluation of the quality of data, analysis of the data, and presentation of conclusions. The first step is a clear identification of the trouble that the review is addressing and the purpose of the review. Literature search should clearly address problems such every bit search terms, the databases used, additional search strategies, and the inclusion and exclusion criteria for determining relevant primary sources. For evaluating and interpreting the quality of included studies, no golden standard exists.[x] The American Clan of Critical Intendance Nurses' (AACN) Evidence-Leveling Hierarchy[11] has been effectively used for grading in the integrative review method, where various master sources (such every bit quantitative and qualitative studies) are included.[12,13] In the data analysis process, information from primary sources are ordered, coded, categorized, and summarized into a unified and integrated conclusion. Finally, conclusions of reviews can exist reported in a tabular array or diagram.[10]

A systematic search was conducted using six online databases: CINAHL, Medline, ERIC, PROQUEST, and two Iranian databases: Islamic republic of iran Medex, and Scientific Information Database. Keywords used for this review were "organisational commitment" or "organizational commitment" with limitation to studies conducted in nursing. The inclusion criteria were: (a) Works written in English or Persian in the timeframe of 2000 through March 2013, (b) the inclusion of the search term in the championship or the keywords, (c) scholarly works published in a peer-reviewed journals, and (d) studies including nurses who worked only in hospitals. Studies that used a mixed sample of nurses forth with other healthcare workers were included if only the studies consistently analyzed and reported nurses' information separately from other participants. The studies that were excluded included those described in one-page reviews, letters, and those published in other than the selected languages. Furthermore, additional papers from reference lists of the studies reviewed were identified. The purpose of this written report was to identify the determinants of nurses' OC; therefore, those studies that practical experimental pattern were excluded with the goal of improved understanding of factors influencing OC in the absenteeism of variable manipulation. The search was completed in April 2013.

The initial search resulted in a sample of 594 articles (464 English and 130 Persian manufactures). In lite of the inclusion and exclusion criteria, 33 studies remained in our review [Table 1].

Table 1

A summary of reviewed studies

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Measures

In the electric current review, studies were evaluated for quality using the AACN revised evidence-leveling arrangement. The new AACN structure consists of half-dozen rating levels. Meta-analyses and meta-syntheses are placed equally the highest levels of prove (Level A). Level B includes both randomized and non-randomized well-designed controlled studies. Level C encompasses qualitative studies, descriptive or correlational studies, integrative reviews, systematic reviews, or randomized controlled trials with inconsistent results. Level D indicates peer-reviewed professional organizational standards. Level E signifies theory-based evidence from multiple-case reports and expert opinion, and Level Thousand is used to identify manufacturer recommendations.[11] In the current review, 32 out of the 33 included studies (96.9%) used a quantitative cross-exclusive blueprint. McNeese-Smith used a qualitative method, however.[40] Therefore, as presented in Tabular array ane, near all the included studies were descriptive in nature with about receiving a level C rating.

Analytic strategy

The data were analyzed with consideration of purpose, methods, and findings of the reviewed studies. Taking into consideration the main findings, descriptions of determinants of OC were first extracted and the way these factors afflicted OC was identified and summarized. And then, based on mutual meanings and central issues of these findings, they were organized and integrated every bit categories and themes. A summary of 4 primary categories and their themes was emerged and are presented in Table 2.

Tabular array 2

Summary of determinants of nurses' OC

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RESULTS

Measurement of OC and methodological aspects of the studies reviewed

The three scales adult by Allen and Meyer (1990), Meyer et al. (1993), and Meyer and Allen (1997) were used in 17 out of 33 included studies.[14,16,17,18,22,23,24,25,29,31,32,33,34,35,41,42,44] According to Meyer and Allen, OC contains the following 3 dimensions: (ane) Melancholia commitment that refers to the members of an organization who are emotionally attached to, identify themselves with, and feel devoted to an organization; (2) continuance commitment that describes the employees who are committed because they believe the costs associated with leaving the arrangement are too high and, hence, they remain; and (3) normative commitment that refers to the group of employees who experience like they should stay with the system across a sense of obligation.[47] It is noteworthy that eleven studies used the affective OC subscale of each of the above scales.[18,22,23,24,25,26,27,28,29,xxx,31,32,33,34,35,41,42,44,46]

The 15-item scale by Mowday et al. (1979) was used to measure OC in 7 of the 33 included studies.[xv,26,27,37,38,39,43,45] Yang and Chang (2008) used the calibration adult by Mowday et al. (1982) which independent three dimensions: (1) A potent belief in, and credence of, the organization's goals and values (value commitment); (2) a willingness to exert a considerable effort on behalf of the organization (effort commitment); and (iii) a strong intent or desire to remain with the organization (retention commitment).[45] Chang and Chang[nineteen] and Ho et al.[28] evaluated OC through a researcher-made questionnaire. Leach[36] assessed OC using a 15-item commitment scale adult past Penley and Gould (1988). This scale contains three subscales: Moral commitment (a normative, internalized identification with organization), calculative commitment (a remunerative or compliance involvement in arrangement), and alienative commitment (a negative resistance).[36]

The xv-detail OC scale developed by Porter et al. (1974) was used in Chiok Foong Loke'due south study.[21] Jalonen et al. used a single question to inquire most OC.[30] Finally, in the study of Chang et al.,[xx] OC was measured past Blauetal's (1993) tool, which comprised six items.

In the majority of studies reviewed, nurses' OC was measured using similar tools. Thus, it should exist said that the authors had a similar view of the empirical referents of OC. On the i hand, it can be considered as a potential strength because the results of such studies enable researchers to make international comparisons.

In light of the statistical analysis, all the reviewed studies except three[24,27,36] used multiple regression assay. Moreover, a considerable number of researchers used the Structural Equation Modeling (SEM).[17,22,26,28,35,43,45] It is obvious that applying such statistical technique can be helpful to examination the proposed models of OC in nursing field and, consequently, to develop the torso of cognition in nursing. Some included studies were guided by a theoretical framework[22,32,35,36,41,45] which enhances the validity of the studies.

Determinants of nurses' OC

Personal characteristics and traits of nurses

The category of personal characteristics and traits of nurses encompasses 2 themes including a) biopsychosocial parameters and b) personal and family life.

Regarding the biopsychosocial parameters theme, age was positively correlated with OC in three studies.[20,xxx,36] Besides, age was found to be negatively associated with calculative commitment in one study.[36] In Tsai and Wu's written report, OC was not related to historic period.[43] These findings betoken a demand for more than exploration of impact of age on OC.

Iv studies reported that as task tenure increased, OC increased as well.[15,xx,29,36] However, in Liou and Cheng'southward (2010) report, job tenure was negatively related to OC.[37] Personality trait of extroversion, as a third psychological factor in this theme, positively influenced OC.[xv] Furthermore, mental wellness, emotional intelligence,[sixteen] and well-beingness[17] were found to be associated with increased levels of OC. The other factors included psychological distress,[xxx] individual levels of negative affectivity,[18] and burnout[22,35] that were found to negatively impact OC. Negative affectivity was considered every bit the extent to which sure negative emotions were experienced past nurses. As opposed to these latter factors, psychological empowerment (the psychological state that employees must experience for managerial empowerment interventions to exist successful) positively influenced OC in two studies.[34,41] Inside this theme, factors such equally employee engagement,[17] task satisfaction,[14,xix,21,26,28,29,38] social rewards,[42] and professional person commitment[39] were also identified as positive determinants of nurses' OC. In addition, McNeese-Smith showed that preferring stability to modify positively affected OC.[40] The final gene in this theme was "surface acting" which negatively impacted OC. In surface interim, persons modify and control their emotional expressions. Inauthentic surface interim may issue over fourth dimension in a feeling of detachment from one'southward true feelings.[45]

5 factors formed the theme of personal and family unit life. Life satisfaction was institute to be positively correlated with OC.[44] The remaining four factors included meeting the family's needs, creating a better life for self and family, and having a plan to retire from the organization, all of which were reported as positive determinants of OC.[40]

Leadership and direction manner and behavior

Both nature of relationships and leadership way were themes of influence inside the leadership and management style and behavior category. Nature of relationships included factors such equally psychological rewards from the caput nurse and supervisor incivility which were constructive in shaping the interpersonal relationships between managers and nurses. Commencement, perception of nurses of managers' exercise was cited as an important determinant of OC. For example, in English and Chalon's report, fairness perception of change management was associated with higher levels of affective delivery.[25] Also, a positive correlation was reported betwixt OC and relational justice. Relational justice refers to the extent to which employees perceive the supervisor equally treating them with politeness and consideration.[xxx] Finally, the researchers institute that both psychological rewards received from the caput nurse[23] and trust in direction[33] were positive predictors of OC. In contrast to the four factors described, the remaining two factors within nature of relationships theme, i.e., supervisor in civility[35,41] and employee cynicism, were negatively related to OC.[25] According to English language and Chalon who studied the relationship betwixt employee pessimism and OC, employee cynicism is targeted toward senior management and stems from perceptions of unfair management practices.[25]

Organizational context

Two themes were identified within this category: Organization's norms and performance and organizational policies and procedures.

Organization's norms and functioning theme focused on findings almost the perception held by nurses concerning organizational climate and practise. As presented in Table ii, this theme included eight factors. First, positive perceptions of the fairness of personnel practices (procedural justice and interactional justice) were positively related to OC.[25] Conversely, lack of fairness from system was related to lack of OC in the study of McNeese-Smith.[40] As the side by side cistron, favorable perception of internal marketing was noted as a positive predictor of OC.[43] The concept of internal marketing argues that enterprises should value and respect their employees by treating them equally internal customers. Some other factor identified was perceived organizational back up, which was institute to be associated with increased levels of OC.[17] In one written report, perception of organizational culture (emotional climate, practice issues, and collaborative relations) was a strong positive predictor of nurses' OC.[26] Inside this theme, organizational trust was also a positive predictor of commitment among nurses.[31] The relationship betwixt OC and psychological contracts, as another gene, was constitute to exist positive in the written report of Kafashpour et al.[31] These authors defined psychological contract equally the individual'south idea near common obligations in the context of the human relationship between the employer and the employee. Finally, factors related to organizational climate such as warmth, conflicts, and standards were shown to be positively correlated with higher levels of OC.[37]

The organizational policies and procedures theme encompasses ii factors: Permanent job status/chore security and monetary benefits. Change from temporary job condition to a permanent one predicted sustained OC of the staff nurses in 2 studies.[27,xxx] Consequent with this finding, job security was 1 of the emerged factors in the study conducted by McNeese-Smith.[40] Also, in the above-mentioned report, nurses cited budgetary benefits as one of the factors shaping loftier-level commitment.

Characteristics of job and work environment

This category included three themes: Growth and development, content and organization of tasks, and mutual respect.

Growth and development theme consisted of vii studies that examined the influence of appropriate role operation and career evolution on OC. Chang et al.[20] found that the gap between career needs and career development programs made negative contributions to OC. In 5 studies, having admission to conditions that enabled optimal office performance of the nurses (structural empowerment) positively influenced affective OC.[22,33,34,35,36,37,38,39,41] A negative correlation between uncertainty of patients' treatment and affective OC was also reported.[xviii] Finally, existence in a learning surroundings, modern applied science, the opportunity for acquiring new skills, and continuing education were institute to be associated with higher levels of OC.[twoscore]

Several factors related to the nature of nurses' tasks and work environment conditions were integrated into the content and organization of tasks theme. A favorable perception of work environs conditions, such equally interpersonal relationships, managerial support, and regular routines, was found to be positively associated with higher levels of affective commitment in ii studies.[42,44] Job control[30] and task rotation[28] were cited every bit significant determinants of OC. In two of the included studies, the perception of part disharmonize and ambiguity were negatively related to nurses' OC.[xviii,39] Also, significant positive relationships between OC, professional privilege,[42] workplace spirituality,[32] and clinical challenges[42] were reported. In McNeese-Smith's study,[40] difficult or repetitive patient care negatively influenced OC. In addition, time pressure level,[eighteen] chore stress,[39,35] and overload[40] were found to exist negative determinants of OC.

Focus of mutual respect theme covered interpersonal relationships existing in the piece of work environment. Ane of the factors within this theme was participative prophylactic,[42] which was institute to exist a positive determinant of nurses' OC. By and large, participative safety was conceptualized equally the extent to which the interpersonal temper was non-threatening in the written report of Jalonen et al.[30] Workplace violence,[eighteen,24] bullying, and internal emotional corruption[24] were identified as negative determinants of OC. According to Demir and Rodwell,[24] internal emotional abuse points out to types of workplace violence exerted by coworkers or supervisors. Consistent with these findings, McNeese-Smith[40] reported that having practiced relations with coworkers was associated with college levels of OC. Finally, nurses' satisfaction with psychological rewards received from physicians was identified to positively impact their melancholia OC.[23]

DISCUSSION

The purpose of this integrative review was to examine in literature and integrate the determinants of nurses' OC in hospital settings. Different factors from 33 included studies were integrated into 9 themes. Afterwards, based on the common meanings and the relationships between the themes, this rather large number of themes was combined into four main categories. The categories included: Personal characteristics and traits of nurses, leadership and management style and behavior, perception of organizational context, and characteristics of task and work surround. Factors within each theme were found to positively or negatively influence the OC of nurses working in hospitals. The current review also showed that research was inconsistent with respect to the correlation between some personal factors such equally historic period and OC. A possible statement is that these findings may exist context-specific and should be taken into account when managers want to design initiatives to stimulate nurses' OC. In other words, issues important for a specific age group of nurses in 1 state may not exist as much of import for nurses of the same age group in another land.

A review of literature indicates that many factors influencing OC identified in this study can be improved past specific interventions designed to this end. Job stress, coworker incivility, burnout, piece of work environment atmospheric condition, empowerment, and management style are among these factors.[48,49,50,51,52,53]

In addition, every bit noted previously, researchers believed that different generations of nurses accept unique perspectives of OC. Employees born into a generational cohort of peers have similar life experiences. These experiences accept strong effects on their work values and needs equally well as their expectations of employers, which in turn touch on the influential parameters of employees' OC. Every bit an case, Carver and Candela[9] believed that nurses born during 1961-1981 prefer working independently, while younger ones enjoy working in groups.[9] And so, it can be expected the integrated findings in the current review provide a foundation for comparison of factors that contribute to OC of dissimilar generations of nurses. Farther, these findings have potential for developing the body of knowledge related to OC in nursing context and clarifying theoretical basis of this concept.

As another finding in this study, it became evident that all the tools applied for measuring nurses' OC were developed in western countries. It has been suggested that the concept of OC is culturally specific.[five] Since work civilisation varies in different countries, the conceptual framework and operationalization of commitment may exist understood differently beyond various countries.[54] Information technology is not meant that tools developed in western countries are not valid in other countries such every bit Iran; it merely ways that these tools need to be tested more in other cultures before their validity can be fully established. On the other hand, healthcare organizations in different countries face dissimilar challenges, which in plow impact the OC of employees. Qualitative enquiry has the potential to offer some insights into nurses' experiences of OC in unlike countries and cultures and, hence, to provide valuable context-based data.

Most of the included studies used a cross-sectional design, and hence, the potential reciprocal relationships between revealed determinants and nurses' OC cannot be fully interpreted causally. Therefore, as far as possible, future research could be conducted using longitudinal designs to further consider the impact of the specific determinants of OC.

Also, just iii studies addressed anonymity of respondents.[23,32,43] This limitation may accept influenced the responses to some extent if nurses felt worried about loss of their task position in infirmary. Also, all the studies reviewed relied upon self-report of OC levels when assessing determinants. In the futurity studies, researchers may need to examine the OC amongst nurses using information triangulation that refers to the utilise of multiple methods of information sources to validate conclusions. For example, the nurses' performance and questions regarding their performance appraisal should exist included in the assessment of OC. In addition, measurement of the level of OC, along with the related outcomes such as nurse turnover,[55] may contribute to a broader agreement of nurses' feelings toward their organizations. Moreover, positive results bias should not exist ignored when interpreting the results of the electric current review. Positive results bias means that the researchers who obtain positive findings are more likely to submit their papers to a journal. Nevertheless, the included studies had considerable strengths. Notably, all but 4 studies drew their samples from more than than 1 site, which in turn might have increased the generalizability of studies included.[21,24,31,45]

We acknowledge that this review has some limitations. In the present review, only those studies published in English and Persian were included. This may accept resulted in the omission of several valuable studies. Too, information technology is evident that OC is an important construct in turnover research. Considering the selected inclusion criteria in this review, we may have perchance missed research studies that have looked at the antecedents and consequences of OC in the context of turnover.

CONCLUSION

Nurses' OC is influenced by various factors related to personal characteristics, leadership and management, organizational context, and characteristics of chore and work surroundings. Given the different work cultures across the globe, withal, little is known almost the relative significance of each cistron among nurses working in different countries. These issues should be taken into account in planning the evidence-based strategies to improve nurses' OC. For this end, qualitative research volition exist an invaluable tool. These studies will capture the real perception of nurses virtually OC and specific factors impacting it. The findings of the nowadays written report could be useful for formulating initiatives to stimulate nurses' OC. In future researches, reviewing this construct, specifically in the context of turnover, can be considered. As the side by side footstep, researchers are recommended to plan research studies that will reveal the causes of loftier OC on which organizations can influence direct. Hereafter inquiry can too exist designed to compare the influential factors on OC in different generations of nurses in countries such as Islamic republic of iran with its specific social and economical context. Finally, regarding the used scales for measuring the OC, futurity inquiry tin can be directed to test the psychometric properties of the OC scales for nurses in the unlike societies or cultures.

Footnotes

Source of Support: Nil

Conflict of Interest: None declared.

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Articles from Iranian Journal of Nursing and Midwifery Research are provided here courtesy of Wolters Kluwer -- Medknow Publications


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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4815364/

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