Abstract

Using the Theory of Planned Behavior to Explore the Multicultural Nursing Workforces�?? Behavioral Intentions to Comply with Nursing Policies and Procedures in Saudi Hospital

The nursing shortage in the Kingdom of Saudi Arabia (KSA) causes administrative difficulties and increases worries about the quality of healthcare,
as well as contributing to a highly multicultural nursing workforce. The further complexities occur when work environments have a multicultural
nursing workforce where nurses of different cultures interact with each other, which can lead to influencing on their compliance with nursing
policies and procedures in Saudi healthcare organizations. However, it has been shown that positive attitudes, behavioral norms and the beliefs are
all significantly associated with nurses’ compliance with nursing policies and procedures. Evidence indicates that although nurses are increasingly
compliant with nursing policies and procedures to ensure a higher quality of nursing care, there is still a wide variance in their compliance. The
utility of the Theory of Planned Behaviour (TPB) has not been previously used in explaining this variance in the multicultural nursing workforce.
Aim: The aim of this study was to examine the utility of the TPB in explaining variations in nurses’ intentions to comply with pre- operative skin
preparation policy.
Method: A mixed methods approach was adopted to determine and examine the important psychosocial factors of nurses in complying with
the pre-operative skin preparation policy. Phase one was an exploratory study to demonstrate how an elicitation method can be used to identify
salient beliefs regarding the compliance with the pre- operative skin preparation policy among a multicultural nursing workforce. The results of
phase one contributed to the development of the final theory-based questionnaire of the TPB using a quantitative study for phase two, which
involved a cross-sectional survey to help begin to understand the beliefs underpinning an nurse’s behavioural intention to comply with the preoperative
skin preparation policy. An anonymous and self-administered questionnaire were designed to assess the variables in the TPB, and
included measures of behavioural intention to comply with pre- operative skin preparation policy, attitudes, subjective norms, and Perceived
Behavioural Control (PBC). A logistic regression analysis was used to test the relationships between the behavioural intention and the TPB variables.
Results and discussion: The results revealed that the TPB model explained up to 40% of variance in behavioural intention to comply with the
pre-operative skin preparation policy. Results indicated that the attitudes (OR= 3.86, 95% CI= 2.07-7.20, P<0.05) and subjective norms (OR=3.37,
95% CI=1.71-6.64, P<0.05) significantly predicted high behavioural intention; however, PBC (OR=1.30, 95% CI= 0.81-2.09, P=0.28) did not.
Conclusion: The findings of this study support the utility of the TPB model in predicting nurses’ high behavioural intention to carry
out the compliance with the pre-operative skin preparation policy. Interventions that address nurses’ attitudes, subjective norms
could be necessary to raise their high behavioural intention to carry out the compliance when it becomes available. Future studies can
build on this study through seeking to replicate the results that reported in this study and expanding the list of contextual variables.


Author(s): Ahmed Ali M. Alyami

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