Original Article

The association between spirituality and Stress with occupational ethics through mediating role of Job Enthusiasm among nurses in Zahedan City, 2017

Reza Norouzi1, Shahriar Dargahi2,*, Nader Aeyadi3, Mahdieh Sarhaddi1

1- Faculty Member, Payame Noor University, Tehran, Iran. 2- PhD Student in Counseling, University of Mohaghegh Ardabili, Ardabil, Iran. 3- MA in Family Counseling, Faculty of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran.

Article Info Abstract

* Corresponding authors: Background: Observing ethical principles is a part of nursing occupation Shahriar Dargahi, and nurses should be aware of the importance of this subject when E-mail: providing nursing care in order to provide their skills based on occupational ethics. Therefore, this study was conducted with the aim to investigate the [email protected] relationship between and the workplace spirituality with the nurses’ occupational ethics through the mediating role of job Article history enthusiasm. Received: Oct, 2017 Materials and Methods: This was a cross sectional-descriptive study. The Accepted: Dec, 2017 study population consisted all man and woman nurses working at hospitals

in Zahedan City, Iran. Cluster sampling method was used to select the sample group. A total of 160 nurses were selected as the sample for the Print ISSN: 2251-8096 study. To collect data, the organizational spirituality questionnaire proposed Online ISSN: 2252-0902 by Milliman, et al., standard occupational ethics questionnaire by Gregory C. Petty and Expanded Nursing Stress Scale (ENSS) by French et al., and job enthusiasm questionnaire were used. The data were analyzed using path analyzing method. Results: The present study showed that the job enthusiasm variable plays Peer review under a mediating role between workplace spirituality and occupational stress responsibility of Journal of with the nurses’ occupational ethics (P < 0.001). In addition, the positive Occupational Health and effect of workplace spirituality (0.277) and negative occupational stress (- Epidemiology 0.204) was significant on occupational ethics (P < 0.001). Conclusions: The results of the study, in line with other studies, show that occupational stress and workplace spirituality with impact on job

Downloaded from johe.rums.ac.ir at 23:53 +0330 on Saturday October 2nd 2021 [ DOI: 10.29252/johe.7.1.3 ] enthusiasm can explain the occupational ethics of nurses.

Keywords: Workplace, Spirituality, Occupational Stress, Ethics, Nurses

Introduction communication with the patient. In practice, it is impossible to distinguish between ethics Occupational ethics refer to the rules and and clinical practice. Therefore, ethical standards for occupational behavior of behavior along with the responsibility of individuals (1). The ultimate aim of the nurses can be considered as effective nursing occupation is to serve human factors in improving and returning the health beings and to realize this only through of patients (2). Nurses are ethically scientific and ethical care and proper responsible and should be responsive for © The Author(s) 2018. Published by Rafsanjan University of Medical Sciences Press. All rights reserved. For permissions, please e-mail: [email protected], [email protected] JOHE, Winter 2018; 7 (1) 3 R. Norouzi et al

their behaviors (3). Patient care is an directly and indirectly improve important concept and indeed the art of organizational performance, profitability and nursing and requires the individual, social, effectiveness. Researches suggest that moral, and spiritual ability of the nurse to there is a relationship between occupational provide good and ethical care. Based on the ethics and spirituality in the occupational nature of nursing, more attention must be performance of nurses (12, 13). paid to care ethics compared to therapeutic Job enthusiasm indicates the amount of considerations. Researches haves shown incentives and interests of employees in that there is a negative and significant their 's identity. Therefore, the relationship between the general index of job enthusiasm can be considered as the occupation ethics and all its dimensions with amount of energy that a person spends for occupational stress (4). his or her job; it can also be taken into Today, occupational stress can be observed account as the work effectiveness (14(. In in all occupations and has created many fact, job enthusiasm as a positive problems for individuals and . phenomenon in the workplace, is very Meanwhile, National Institute for significant for the absence of negative Occupational Safety and Health (NIOSH) consequences like occupational burnout, has introduced nursing at the top of 40 error and in the job, and lack of occupations with a high incidence of stress- work from the point of view of conservation related illnesses, and believes that nursing of resources (15). is at the head of high-level careers among Given that job enthusiasm is defined as a healthcare occupations (5, 6). Nursing cognitive commitment to the organization, or occupational stress has a high level of the amount of purely endearing work that physical and mental illness for nurses and the individual shows in his/her work affects their mental well-being (7). environment, job enthusiasm can be linked Occupational stress and its outcomes make to other variables including occupational nurses follow their work responsibilities with ethics (16). Zahed et al. (17) concluded that disappointment and lack of motivation (8). occupational ethics had a direct effect on This healthcare team have close contact job enthusiasm. The support of colleagues with patients, and hence, they are and supervisors, feedback from constantly faced with ethical decision- performance, of duty and making (9). autonomy and learning opportunities are Workplace spirituality describes the among the sources that increase the experience of employees who perform their employee's job enthusiasm )17(. Job tasks with energy, are internally satisfied enthusiasm plays a mediating role in the with their work, understand the meaning relationship between the psychological Downloaded from johe.rums.ac.ir at 23:53 +0330 on Saturday October 2nd 2021 [ DOI: 10.29252/johe.7.1.3 ] and purpose of their work, and feel that they climate, perceived organizational support have effective communication with their and organizational outcomes like job colleagues )10(. The study of workplace performance. Moreover, job enthusiasm is spirituality can be a powerful positive force correlated with nursing stress (18). for the lives of individuals and may make When organizational behavior is morally them work longer, more balanced and weak, the cost of performance increases meaningful. Moreover, Millman et al. (11) explicitly and implicitly. These costs can be argued that workplace spirituality improves identified in different areas of the employee attitudes including, increased job organization including low productivity, satisfaction, job engagement, decreased slowness of organization dynamics, lack of workplace leave intentions, and increased transparency and congestion of organizational commitment. All of these communications. Based on the viewpoints

JOHE, Winter 2018; 7 (1) 4 Workplace spirituality and occupational stress, ethics and enthusiasm

of the researchers and experts, the factors (200) was filled completely by the like structure, technology and equipment respondents. are not the only reasons for the success of The study inclusion criteria included working organizations, rather immaterial and at the hospital for at least 2 years and lack spiritual factors have also been effective in of the psychiatric problems. In addition, the this issue (19). Therefore, considering the exclusion criteria were the absence of any importance of occupational ethics in of these two cases. increasing the efficiency and effectiveness By following ethical considerations like of manpower, especially in health care and confidentiality of information and informed hospital climate, and due to the ignorance of consent of individuals, self-report the indirect effect of workplace spirituality questionnaires were completed by nurses. and occupational stress on occupational Data were collected using the Nursing ethics among nurses in research literature, Stress Scale (NSS) questionnaire presented the present study was carried out to by Gray-Toft and Anderson (21). This determine the relationship between questionnaire consisted of 34 questions in occupational stress and workplace the dimensions of patient suffering and spirituality with the occupational ethics of death, involvement with physicians, lack of nurses through the mediating role of job readiness, lack of support, involvement with enthusiasm. In this study, the following other nurses, pressure, and uncertainty hypotheses were investigated: 1- about treatment with 7, 5, 3, 3, 5, 6, and 5 workplace spirituality and occupational questions, respectively. The questions of stress have a direct impact on the this tool were based on Likert scale with occupational ethics of nurses. 2- Working four options as not stressful, rarely stressful, spirituality affects the occupational ethics of sometimes stressful, and always stressful nurses by increasing job enthusiasm. 3- with a score of 1, 2, 3, and 4, respectively. Occupational stress affects nurses' The range of scores was 34-136 and the occupational ethics through reducing job scoring was as follows: scores less than or enthusiasm. equal to 68, 69-103, and equal to 104 or higher indicated low, average and high Materials and Methods stress, respectively. In a study by Rezaee (22), the reliability of the test was obtained This was a cross sectional-descriptive study through Cronbach's alpha coefficient as conducted on all nurses working at 0.74, 0.76, 0.76, 0.76, 0.74, 0.74, and 0.74 hospitals in Zahedan City in 2017. The for dimensions of patient's suffering and convenient sampling method was used to death, conflict with the doctor, lack of select the subjects; therefore, with the adequate readiness, lack of adequate

Downloaded from johe.rums.ac.ir at 23:53 +0330 on Saturday October 2nd 2021 [ DOI: 10.29252/johe.7.1.3 ] permission and collaboration of 6 existing support resources, high working volume, hospitals, 30 subjects were selected from conflict with other nurses, and uncertainty each hospital, hence a total of 180 nurses about treatment, respectively. were selected as the study population. This The occupational ethics questionnaire was number of subjects was selected to developed by Gregory C. Petty and includes represent the real community. Acording to 23 items (23). The four dimensions of Anderson (20), the minimum number of the occupational ethics from Petty's point of subjects should be 150 individuals. view were: attachment and interest in work, Researchers attended hospitals after the perseverance and seriousness in work, data collection questionnaires were healthy and human relationships at work, presented to the nurses. 90% of the total and collective spirit and participation in the number of the distributed questionnaires work with score ranges of 1-6, 7-12, 13-17,

JOHE, Winter 2018; 7 (1) 5 R. Norouzi et al

and 18-23, respectively. This questionnaire in order to measure the organizational was based on the Likert scale with options spirituality. This questionnaire included 20 as completely disagree, disagree, neutral questions and 3 components. The scoring agree, and completely agree, with a score method in this questionnaire was based on of 1, 2, 3, 4, and 5, respectively. For the the five-point Likert scale as completely whole scale, the minimum and maximum disagree to completely agree with a score score was 23 and 92, respectively. Higher range of 1 to 5, respectively. For the whole scores reflect more occupational ethics. scale, the minimum and maximum scores This questionnaire had the necessary were 20 and 100, respectively. Moreover, content validity due to the appropriate this questionnaire has been used in various theoretical foundation and confirmation of studies so far, and the calculated the experts. There was no reverse Cronbach’s alpha coefficient was 0.87 for questions in the questionnaire. In the study this scale (28). by Salehi et al. (24), the face, content and The data were analyzed using descriptive structure validity of the questionnaire was statistics and path analyzing method and evaluated and its reliability was confirmed the 18 Amos software. Moreover, the by calculating the Cronbach's alpha Kolmogorov–Smirnov (K-S) test was used coefficient. to ensure the normal data distribution. The job enthusiasm questionnaire contained Furthermore, a significance level of 0.05 18 questions with the aim to measure the was considered. degree of job enthusiasm among the individuals in terms of the dimensions of Results enthusiasm, endowment for work, and Among all the participants in the study, 96 attraction in work (25). The response scale (53.33) and 84 (46.67) were women and of the questionnaire was based on Likert men, respectively. In addition, 117 (65.00) scale with options of very low, low, and 63 (35.00) of the subjects were married sometimes, high, and very high with scores and single, respectively. 36 (20.00) and 144 of 1, 2, 3, 4, and 5, respectively, however, (80.00) of the participants worked in the this scoring method was inverse in emergency department and the non- questions 5, 10, and 17. For the whole governmental sector, respectively. The scale, the minimum and maximum score mean and standard deviation (SD) of the was 18 and 90, respectively. To total score variables studied and their dimensions have of the questionnaire was obtained summing been presented in table 1. The K-S test up the total scores of all questions together. results indicated that the scores were in Higher scores reflected more enthusiasm of normal levels. nurses at work and vice versa (25). In the

Downloaded from johe.rums.ac.ir at 23:53 +0330 on Saturday October 2nd 2021 [ DOI: 10.29252/johe.7.1.3 ] Before examining the research hypotheses study by Kabirzadeh )26,( the content in order to obtain more information, the role validity of this test was verified and of the predictor of organizational spirituality, confirmed by the experts. Furthermore, the and occupational stress and enthusiasm reliability of the questionnaire was was studied on occupational ethics. The calculated using Cronbach's alpha correlation coefficient of the organizational coefficient. The Cronbach's alpha coefficient spirituality, and occupational stress and was obtained as 0.69, 0.71, and 0.65 for the enthusiasm with professional ethics was R dimensions of job enthusiasm, endowment = 611, indicating a high correlation between for work, and attraction in work, these variables. This correlation coefficient respectively. showed that 47.60% of the variance of the The organizational spirituality questionnaire professional ethics involved in the study proposed by Milliman, et al. (27) was used

JOHE, Winter 2018; 7 (1) 6 Workplace spirituality and occupational stress, ethics and enthusiasm

was explained by the variables of path analysis should be confirmed in order organizational spirituality, and occupational to examine the mediating role of job stress and enthusiasm. The role of all three enthusiasm variables among occupational variables was also significant in predicting stress and organizational spirituality with the the occupational ethics (P < 0.001). The occupational ethics.

Table 1: Mean and standard deviation (SD) of the studied variables among nurses working in hospitals in Zahedan City, Iran Variables Mean ± SD Male Female Minimum Maximum Workplace spirituality 44.56 ± 4.09 45.21 ± 4.33 22 71 Occupational stress 83.61 ± 3.16 86.90 ± 4.63 37 120 Occupational 34.79 ± 3.02 33.31 ± 5.51 20 61 enthusiasm Occupational ethics 58.61 ± 3.21 63.42 ± 5.89 50 90

As shown in figure 1, all three path effect on occupational ethics with increasing coefficients are significant (P < 0.001). In job enthusiasm. Occupational stress other words, organizational spirituality and affected the occupational ethics indirectly occupational stress have a direct effect on with reducing job enthusiasm. The fit indices occupational ethics. Moreover, the of the model are presented in table 2 to organizational spirituality had an indirect confirm the proposed model.

Figure 1: Fitted model for mediating role of job enthusiasm in the relationship between organizational spirituality and occupational stress with occupational ethics (All three path coefficients were significant) (P < 0.001)

Downloaded from johe.rums.ac.ir at 23:53 +0330 on Saturday October 2nd 2021 [ DOI: 10.29252/johe.7.1.3 ] As shown in table 2, the value of chi-square be said that the proposed model has index is not significant (P > 0.050), and all fit reasonable fitness and the study indices of the model have also reached the hypotheses have been confirmed. reasonable fit criterion. Goodness of fit Therefore, according to these findings, it index (GFI) and comparative fit index (CFI) can be concluded that job enthusiasm plays are above 0.90, which are reasonable for a significant mediating role in the model fitness. The root mean square error relationship between organizational of approximation (RMSEA) was also 0.056 spirituality and occupational stress with which is reasonable. occupational ethics. Regarding the fit indices of the model, it can

JOHE, Winter 2018; 7 (1) 7 R. Norouzi et al

Table 2: Model fit indices

Index χ2 P GFI AGFI CFI RMSEA Value 1.905 0.206 0.991 0.958 0.991 0.056

GFI: Goodness-of-fit; AGFI: Adjusted goodness-of-fit index; CFI: Comparative fit index; RMSEA: Root mean square error of approximation

Discussion which results in tasks being carried out in less time and with more interest. This could The first finding of the study indicates that support the role of enthusiasm in improving spirituality has a direct effect on nurses’ professional ethics (14). occupational ethics. This result is consistent Furthermore, despite the inner motive for with the results presented in (29). Since, work and its satisfaction, the values of the individuals with high workplace spirituality organization are maintained without are more responsible, moral and supervision of others. Therefore, the direct hardworking, and these attributes are effect of job engagement on professional associated with hope for the future and ethics seems natural. interest and commitment to work. Regarding the findings for the effect of The second finding of the research occupational stress and workplace suggests that occupational stress and spirituality on nurses’ occupational ethics workplace spirituality has a direct effect on through job enthusiasm, it can be argued occupational ethics. The results of the that nurses with high spirituality in work studies by Soleimani (30) and Burke (31) have high interactions with colleagues and and (13) are in line with those of the present feel pleasure from work and use of full study. Stress is one of the most acute individual power in accordance with the problems of today's organizations which goals and values of the organization. These endangers the physical and mental health of features will automatically enhance their the workforce and expose heavy burden on potential capabilities in the workplace, organizations. Regarding the stressful hence individuals perform their tasks nature of nursing occupation and its effect enthusiastically and with the pleasure. The on burnout due to this occupation (32), it enthusiastic nurses are not only loyal, can be indicated that the perception of consistent with organizational goals and these stressful situations and the values, but also have a strong incentive and occurrence of burnout can affect the work are struggling with more enthusiasm. ethics of nurses. Moreover, it has meaning Burke (30) also stated the consequences of in working alongside stressors in work and occupational stress including reduction of work environment, identifying and Downloaded from johe.rums.ac.ir at 23:53 +0330 on Saturday October 2nd 2021 [ DOI: 10.29252/johe.7.1.3 ] adherence to organizational ethics, preserving real values in work leads to resorting to behaviors to avoid work ethical and professional principles in responsibilities, interruptions in effective organizations. communication and emotional interruption Another finding of the study suggests that with the client. In a study by Marchese et al. the job enthusiasm has a direct effect on (33), it was also shown that employees occupational ethics. The higher job need to make good choices in balancing enthusiasm among the nurses leads to a work demands and family responsibilities; higher degree of occupational ethics. Job otherwise, in addition to tolerating stress enthusiasm among the employees is a and tension, they will experience moral factor that adds value to the organization degradation. Regarding the sources of and involves conscious and voluntary work nurses' occupational stress and the nature of the staff to increase their career level,

JOHE, Winter 2018; 7 (1) 8 Workplace spirituality and occupational stress, ethics and enthusiasm

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