Factors affecting the performance of public health nurses in family nursing care

Abstract

Objective

To determine factors that influence the nurses’ performance in family nursing care in public health centers in Jambi City.

Method

A cross-sectional study was conducted from April to October 2016 using questionnaire with public health nurses as participants. The survey included questions on knowledge, attitude, self-confidence, motivation, personality, and nurses’ performance in family nursing care, and was completed by 114 nurses. Data analyses used for this study were chi-square test and logistic regression.

Results

The factors affecting the nurses’ performance in family nursing care were attitudes (p 0.003; 95% CI 1.583–9.823), motivation (p 0.002; 95% CI 1.672–9.972), and personality (p 0.005; 95% CI 1.466–8.830).

Conclusions

Need efforts to improve the attitude, motivation, and personality of nurses in providing family nursing care, such as training, supervision, and rewards.

Introduction

Nurses who work in public health centers have the primary responsibility to carry out nursing care services to clients, both individuals, families, special groups, and the community.¹ The evaluation of nurse's role and function in public health centers showed that many nurses’ focus to curative care in providing nursing care, while implemented family nursing care was not optimal. This happens because of a lack of nurses’ ability to carry out family nursing care activities caused by limited nursing care training and many abundant tasks for nurses.² Data National Health Facility Research in 2011 show that the achievement of family nursing care in public health center throughout Indonesia was 61% from a national target.³

Tafwidhah et al.’s⁴ study entitled “The Public Health Nurses’ Competencies and the Level of Implementation PHN in Pontianak” shows that there is a relationship competency of public health nurses with the level implementation PHN (p-value = 0.000; α = 0.05). Amperaningsih and Agustantis’⁵ study entitled “Nurse's Performance in Implementation of Public Health Nursing (PHN)” showed that implementation of PHN activities are not running (80%).

The initial survey to three community health coordinators in public health center of Jambi City found that the three public health center had carried out community service activities, especially family nursing care. But, 2 persons said that the implementation was not expected because there were many public health nurses were lazy to go to the field and felt forced to do home visits, and had not documented their activities. Whereas 1 person community health coordinator said that public health care activities were going well and each nurse had the awareness to carry out family nursing care. Three coordinators said that each functional nurse had an obligation to carry out a nursing care in four vulnerable/poor families every month and the head of the public health center provided the opportunity for nurses to take to the field. It is necessary a study find how the nurse's performance in family nursing care and the factors that influence it.

Method

This study was a descriptive analytic study with a cross-sectional design. The independent variables are individual nurse factors (knowledge, attitude, self-confidence, motivation, and personality); and the dependent variable is the performance of nurses in family nursing care. The study was conducted in April to October 2016 in 18 public health centers throughout Jambi City. Samples were 114 nurses taken the total sampling. Data explorers were carried out with questionnaires. Data analysis used chi-square and logistic regression.

Results

Table 1 shows that most nurses have good performance in family nursing care (52.6%).

Table 1.

The nurses’ performance in public health centers of Jambi City in family nursing care (n = 114).

Performance	N	%
Good	60	52.6
Not good	54	47.4
Total	114	100.0

In this study (see Table 2), it can be seen that most nurses have good knowledge of family nursing care (65.8%), poor attitude toward family nursing care (57%), poor confidence (50.9%), low motivation (55.3%), and have good personality (53.5%).

Table 2.

The nurse's individual factors in family nursing care (n = 114).

Variable	N	%
Knowledge
Good	75	65.8
Not good	39	34.2
Attitude
Good	49	43.0
Not good	65	57.0
Self-confidence
Good	56	49.1
Not good	58	50.9
Motivation
High	51	44.7
Low	63	55.3
Personality
Good	61	53.5
Not good	53	46.5

Table 3 shows three individual factors that have a significant relationship with the performance of nurses in family nursing care (p-value <0.05), including attitude, motivation, and personality. Author concluded that nurses with good attitudes have 2.9 times chance to show good performance compared to nurses with good enough attitudes (OR = 2.903; 95% CI = 1.3–6.29); nurses with high motivation have an opportunity 3.9 times to show good performance compared to nurses with low motivation (OR = 3900; 95% CI = 1.77–8.6); and nurses with good personalities have 2.7 times the opportunity to show good performance compared to nurses with poor personality (OR = 2.701; 95% CI = 1.3–5.77). Table 3 shows that two individual factors that have no significant relationship with the nurses’ performance in family nursing care (p-value >0.05), including knowledge and confidence.

Table 3.

Relationship of individual factors with nurses’ performance in family nursing care (n = 114).

Individual factors	Nurses’ performance				Total		OR (95% CI)	p-value
	Good		Good enough		N	%
	N	%	N	%
Knowledge
a. Good	37	49.3	38	50.7	75	100	0.677 (0.3–1.48)	0.435
b. Not good	23	59.0	16	41.0	39	100
Total	60	52.6	54	47.4	114	100
Attitude
a. Good	33	67.3	16	32.7	49	100	2.903 (1.3–6.29)	0.011^a
b. Not Good	27	41.5	38	58.5	65	100
Total	60	52.6	54	47.4	114	100
Self-confidence
a. Good	30	53.6	26	46.4	56	100	1.077 (0.5–2.25)	0.992
b. Not good	30	51.7	28	48.3	58	100
Total	60	52.6	54	47.4	114	100
Motivation
a. High	36	70.6	15	29.4	51	100	3.900 (1.77–8.6)	0.001^a
b. Low	24	38.1	39	61.9	63	100
Total	60	52.6	54	47.4	114	100
Personality
a. Good	39	63.9	22	36.1	61	100	2.701 (1.3–5.77)	0.016^a
b. Not good	21	39.6	32	60.4	53	100
Total	60	52.6	54	47.4	114	100

a

Meaningful at α = 0.05.

Based on Table 4, public health nurses with a good attitude have an opportunity of 3.9 times to show good performance compared to nurses with a bad attitude after being controlled by motivation and personality. Too, nurses with high motivation have an opportunity of 4.1 times to show good performance compared to nurses with low motivation after being controlled by attitude and personality. The results of the analysis also show that public health nurses with good personality have an opportunity of 3.6 times to show good performance compared to nurses with good enough personality after being controlled by attitude and motivation.

Table 4.

Multivariate modeling between individual factors and nurses’ performance in family nursing care in public health center of Jambi City.

Variable (individual factors)	B	p	OR	95% CI for exp(β)
				Lower	Upper
Attitude	1.372	0.003^a	3.943	1.583	9.823
Motivation	1.407	0.002^a	4.083	1.672	9.972
Personality	1.280	0.005^a	3.598	1.466	8.830
Constant	−2.128	0.000	0.119

a

Meaningful at α = 0.05.

Discussion

There are several factors that influence the performance of nurses in family nursing care, including environmental factors and individual factors.⁶ Mangkunegara⁷ explained that individual factors that influence nurse performance are knowledge, confidence, motivation, commitment, attitude, personality, demographic background, and learning.

The results of this study get three individual factors that most dominantly affect the performance of nurses in family nursing care, namely motivation, attitude, and personality. This research is in line with the research of Kawata et al.,⁸ entitled “The Performance of the Nurse in Family Health: Building Competence for Care in Ribeirao Preto, Sao Paulo, Brazil”. Their study is qualitative research with results shows that the performance of nurses is determined by knowledge, skills, and attitudes.

Herzberg (2003) in Ref. 9 explained that the efforts made to increase the motivation of nurses were by sending nursing staff to take part in training so that nurses had new knowledge about a procedure, and held consultations about directions, expectations, and obstacles in doing nursing care family. Increased nurse motivation can help maintain the quality of family nursing care in the community (Alderfer, 1972 in Ref. 9).

Attitudes are determinants of behavior because they are linked with perception, personality, and motivation.⁶ Notoatmodjo¹⁰ states that the attitude possessed by a person determines an individual's assessment and response to an object or event.

The author argues that nurses with a good attitude and personality will show good performance, and nurses with a bad attitude and personality will show poor performance. In this study, the negative attitude of nurses is not in line with the high knowledge of nurses. This may be due to the high knowledge of nurses at the stage of knowing and understanding, not yet at the stage of applying the knowledge in their daily work.

According to the author, the poor performance of nurses in family nursing care is not caused by the lack of nurses’ knowledge about family nursing care but may be due to the lack of nurses’ willingness to do family nursing care. Nurses do not want to do it probably because the time of the nurse is not enough to carry it out, lacks motivation, and low awareness.

Conclusions

The nurses’ performance in family nursing care in Public Health Center of Jambi City was mostly in the good category. But, there are nurses show good enough performance. In this study, individual factors that most influence the nurses’ performance in family nursing care were motivation, attitude, and personality. The efforts should be made in improving the attitude, motivation, and personality of nurses, such as training, supervision, and rewards.

Acknowledgements

The author would like to thank Nursing Department Health Polytechnic Ministry of Health in Jambi; Health Office of Jambi City; and all nurses at the Public Health Center in Jambi City.