Determinants of Nurses’ Clinical Performance in Implementing Nursing Care Standards within Inpatient Services: A Practice-Based Perspective at Kota Tinggi Hospital
Abstract
Purpose of the study: This study aimed to analyze the determinants of nurses’ clinical performance in implementing nursing care standards within inpatient services at Kota Tinggi Hospital, Johor.
Methodology: A quantitative analytical study with a cross-sectional design was conducted involving 98 nurses selected through total sampling. Data were collected using structured questionnaires and observation checklists. Statistical analysis included univariate, bivariate (Chi-square), and multivariate (logistic regression) analyses.
Main Findings: The findings revealed that knowledge (p=0.001), motivation (p=0.002), leadership (p=0.000), and compensation (p=0.003) were significantly associated with clinical performance. Leadership was identified as the most dominant factor (OR=3.86). A majority of nurses (64.3%) demonstrated high clinical performance, although a notable proportion (35.7%) showed lower performance.
Novelty/Originality of this study: This study provides a practice-based and integrative analysis of multiple determinants influencing nurses’ clinical performance in inpatient settings, emphasizing the role of leadership in bridging the gap between nursing standards and real clinical implementation.
References
S. Zakariah-Akoto et al., “Anaemia prevention among pregnant women: Views and experiences of pregnant women and antenatal care providers in Accra, Ghana,” World Nutr., vol. 15, no. 2, pp. 87–101, 2024, doi: 10.26596/wn.202415287-101.
B. Negi et al., “Anti-methicillin resistant staphylococcus aureus activity, synergism with oxacillin and molecular docking studies of metronidazole-triazole hybrids,” Eur. J. Med. Chem., vol. 115, no. 3, pp. 426 – 437, 2016, doi: 10.1016/j.ejmech.2016.03.041.
E. Natalie et al., “‘You’re actually part of the team’: A qualitative study of a novel transitional role from medical student to doctor,” BMC Med. Educ., vol. 23, no. 1, pp. 1–10, 2023, doi: 10.1186/s12909-023-04084-9.
A. Gautam, A. Chirputkar, and P. Pathak, “Opportunities and Challenges in the Application of Artificial Intelligence-Based Technologies in the Healthcare Industry,” Int. Interdiscip. Humanit. Conf. Sustain. IIHC 2022 - Proc., pp. 1521–1524, 2022, doi: 10.1109/IIHC55949.2022.10059767.
D. C. Karaferis, D. A. Niakas, D. Balaska, and A. Flokou, “Valuing outpatients’ perspective on primary health care services in greece: A cross-sectional survey on satisfaction and personal-centered care,” Healthcare, vol. 12, no. 14, pp. 1–20, Jul. 2024, doi: 10.3390/healthcare12141427.
K. Singh et al., “Barriers and solutions to the gap between theory and practice in nursing services: A systematic review of qualitative evidence,” Nurs. Forum, vol. 2024, no. 1, 2024, doi: 10.1155/2024/7522900.
M. J. K. DiMattio and S. S. Hudacek, “Educating generation Z: Psychosocial dimensions of the clinical learning environment that predict student satisfaction,” Nurse Educ. Pract., vol. 49, pp. 1-9, 2020, doi: 10.1016/j.nepr.2020.102901.
Chuleeporn Prompahakul and Elizabeth G Epstein, “Moral distress experienced by non-Western nurses: An integrative review,” Nurs. Ethics, vol. 27, no. 3, pp. 778–795, 2019, doi: 10.1177/0969733019880241.
T. Giske et al., “Developing and testing the EPICC spiritual care competency self‐assessment tool for student nurses and midwives,” J. Clin. Nurs., vol. 32, no. 7–8, pp. 1148–1162, 2023, doi: 10.1111/jocn.16261.
P. Guzik and B. Więckowska, “Data distribution analysis – a preliminary approach to quantitative data in biomedical research,” J. Med. Sci., vol. 92, no. 2, pp. 81–96, 2023, doi: 10.20883/medical.e869.
E. P. Motta et al., “The anti-virulence effect of vismia guianensis against Candida albicans and Candida glabrata,” Antibiotics, vol. 11, no. 12, pp. 1–24, 2022, doi: 10.3390/antibiotics11121834.
V. A. Kagonya, O. O. Onyango, M. Maina, D. Gathara, M. English, and A. Imam, “Characterising Support and Care Assistants in Formal Hospital Settings: A Scoping Review,” Human Resources for Health. 10.1186/s12960-023-00877-7
J. S. Park and J. H. Park, “Advanced in algorithms, security, and systems for ICT convergence,” J. Inf. Process. Syst., vol. 16, no. 3, pp. 523–529, 2020, doi: 10.3745/JIPS.03.0141.
M. Burnier and A. Damianaki, “Hypertension as cardiovascular risk factor in chronic kidney disease,” Circ. Res., vol. 132, no. 8, pp. 1050–1063, 2023, doi: 10.1161/CIRCRESAHA.122.321762.
A. P. Knapp, W. Rehmus, and A. Y. Chang, “Skin diseases in displaced populations: A review of contributing factors, challenges, and approaches to care,” Int. J. Dermatol., vol. 59, no. 11, pp. 1299–1311, Nov. 2020, doi: 10.1111/ijd.15063.
H. Barnes, “Realistic mathematics education: Eliciting alternative mathematical conceptions of learners,” African J. Res. Math. Sci. Technol. Educ., vol. 8, no. 1, pp. 53–64, 2004, doi: 10.1080/10288457.2004.10740560.
C. C. Okeke and G. van der Westhuizen, “Learning from professional conversation: A conversation analysis study,” South African J. Educ., vol. 40, no. 1, pp. 1–10, 2020, doi: 10.15700/saje.v40n1a1777.
A. Lilian, “Motivational beliefs, an important contrivance in elevating digital literacy among university students,” Heliyon, vol. 8, no. 12, p. e11913, 2022, doi: 10.1016/j.heliyon.2022.e11913.
C.-C. Chang, C.-G. Kuo, and Y.-H. Chang, “An assessment tool predicts learning effectiveness for project-based learning in enhancing education of sustainability,” Sustainability, vol. 10, no. 10, pp. 3595, 2018, doi: 10.3390/su10103595.
K. I. Krisnadewi, S. A. Kristina, T. M. Andayani, and D. Endarti, “Implementation preventive program for diabetic mellitus (PROLANIS) at Community Health Center in Indonesia: A qualitative study,” J. Appl. Pharm. Sci., vol. 15, no. 01, pp. 153–161, 2024, doi: 10.7324/JAPS.2024.194416.
J. Ahn and J. Kwon, “Green hotel brands in Malaysia: Perceived value, cost, anticipated emotion, and revisit intention,” Curr. Issues Tour., vol. 23, no. 12, pp. 1559–1574, 2020, doi: 10.1080/13683500.2019.1646715.
S. Hamidah and S. Palupi, “Peningkatan soft skills tanggung jawab dan disiplin terintegrasi melalui pembelajaran praktik patiseri,” J. Pendidik. Karakter, vol. 0, no. 2, pp. 143–152, 2012.
R. Rianti, G. Gunawan, N. N. S. P. Verawati, and M. Taufik, “The effect of problem based learning model assisted by phet simulation on understanding physics concepts,” Lensa J. Kependidikan Fis., vol. 12, no. 1, p. 28, 2024, doi: 10.33394/j-lkf.v12i1.8783.
J. K. Limberg et al., “Assessment of resistance vessel function in human skeletal muscle: guidelines for experimental design, Doppler ultrasound, and pharmacology,” Am. J. Physiol. Circ. Physiol., vol. 318, no. 2, pp. H301–H325, 2019, doi: 10.1152/ajpheart.00649.2019.
C. DeLuca, A. Valiquette, A. Coombs, D. LaPointe-McEwan, and U. Luhanga, “Teachers’ approaches to classroom assessment: a large-scale survey,” Assess. Educ. Princ. Policy Pract., vol. 25, no. 4, pp. 355–375, 2018, doi: 10.1080/0969594X.2016.1244514.
N. Pamidi, “Use of essential analogies in clinical anatomy active learning curriculum: A personal reflection,” Transl. Res. Anat., vol. 18, p. 100062, 2020, doi: 10.1016/j.tria.2020.100062.
A. S. Winn et al., “Applying cognitive learning strategies to enhance learning and retention in clinical teaching settings,” MedEdPORTAL, vol. 15, no. 6, pp. 1–7, Nov. 2019, doi: 10.15766/mep_2374-8265.10850.
A. Eshiev, A. Asanov, Z. Moldaliev, D. Eshiev, Arstanbekov, and Mamatzhan, “Influence of environmental factors on the condition of adolescent dental hard tissues : Clinical and physicochemical,” J. Ilm. Ilmu Terap. Univ. Jambi, vol. 9, no. 1, pp. 406–421, 2025, doi: https://doi.org/10.22437/jiituj.v9i1.38513.
S. Kamau et al., “Integration strategies and models to support transition and adaptation of culturally and linguistically diverse nursing staff into healthcare environments: An umbrella review,” Int. J. Nurs. Stud., vol. 136, p. 104377, 2022, doi: 10.1016/j.ijnurstu.2022.104377.
Y. Nakakoji and R. Wilson, “First-year mathematics and its application to science: Evidence of transfer of learning to physics and engineering,” Educ. Sci., vol. 8, no. 1, 2018, doi: 10.3390/educsci8010008.
V. Piercey and E. Militzer, “An inquiry-based quantitative reasoning course for business students,” Primus, vol. 27, no. 7, pp. 693–706, 2017, doi: 10.1080/10511970.2016.1251519.
H. Taherdoost, “What are different research approaches? comprehensive review of qualitative, quantitative, and mixed method research, their applications, types, and limitations,” J. Manag. Sci. Eng. Res., vol. 5, no. 1, pp. 53–63, 2022, doi: 10.30564/jmser.v5i1.4538.
S. W. Lee, “Regression analysis for continuous independent variables in medical research: Statistical standard and guideline of life cycle committee,” Life Cycle, vol. 2, pp. 1–8, 2022, doi: 10.54724/lc.2022.e3.
S. Yule, A. Gupta, P. G. Blair, A. K. Sachdeva, and D. S. Smink, “Gathering validity evidence to adapt the Non-technical Skills for Surgeons (NOTSS) assessment tool to the united states context,” J. Surg. Educ., vol. 78, no. 3, pp. 955–966, May 2021, doi: 10.1016/j.jsurg.2020.09.010.
M. Riza, K. Kartono, and E. Susilaningsih, “Validity and reliability of chemical test instruments for acid and base solutions oriented generic skills science,” J. Educ. Res. Eval., vol. 11, no. 1, pp. 1–8, 2022, doi: 10.15294/jere.v11i1.55450.
V. Phan, L. Wright, and B. Decent, “Addressing competing objectives in allocating funds to scholarships and need-based financial aid,” Proc. 15th Int. Conf. Educ. Data Mining, EDM 2022, no. July, pp. 110–121, 2022, doi: 10.5281/zenodo.6853028.
P. da S. Finamore et al., “Nigerian politicians, discipline, integrity, character and the rule of law: Application versus financial spending in 2019 federal elections,” J. Chem. Inf. Model., vol. 53, no. February, p. 2021, 2021, doi: 10.13140/RG.2.2.19482.59846.
B. Y. Rizkiwati, S. U. M. Widjaja, A. Haryono, H. Wahyono, and M. Z. Majdi, “Financial literacy education models for 7–12 years old based on the local wisdom of sasak tribe Lombok Indonesia,” Pegem Egit. ve Ogr. Derg., vol. 12, no. 2, pp. 58–70, 2022, doi: 10.47750/pegegog.12.02.05.
J. Sinclair, Y. Fan, J. Lin, B. Butters, P. J. Taylor, and N. Chockalingam, “Effects of high heels on medial tibiofemoral cartilage mechanics: an exploration using musculoskeletal simulation and a probabilistic cartilage failure model,” Footwear Sci., vol. 16, no. 1, pp. 25–36, 2024, doi: 10.1080/19424280.2023.2224278.
L. Speight, K. Crawford, and S. Haddelsey, “Towards measures of longitudinal learning gain in uk higher education: The challenge of meaningful engagement,” High. Educ. Pedagog., vol. 3, no. 1, pp. 196–218, 2018, doi: 10.1080/23752696.2018.1476827.
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