Using the theory of planned behaviour to explore the intentions of a multicultural nursing workforce to comply with policies and procedures in the Prince Sultan Military Medical City (PSMMC)

Abstract

The nursing shortage in the Kingdom of Saudi Arabia (KSA) causes administrative difficulties and increases worries about the quality of healthcare being provided, as well as contributing to the employment of a multicultural nursing workforce. 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 that compliance. The Theory of Planned Behaviour (TPB) is a social cognitive model of behaviour used to investigate attitudes and behavioural relationships and to understand individuals’ behavioural intentions in relation to their performance. However, the TPB has not been previously used to attempt to explain this variance in a multicultural nursing workforce.

The aim of this study was to examine the usefulness of the TPB in explaining variations in nurses’ intentions to comply with the pre-operative skin preparation policy. This study consisted of two phases, both conducted within a large military hospital in the KSA. The first phase, an elicitation study, was carried out to identify salient beliefs about compliance behaviour held by nurses working in general surgical areas. The findings from the elicitation study were used to develop the final theory-based questionnaire developed to understand the beliefs underpinning nurses’ intention to comply with the pre-operative skin preparation policy. The second phase of the study involved an anonymous and self-administered questionnaire designed to assess the variables in the TPB. The instrument included measures of behavioural intention to comply with pre-operative skin preparation policy, attitudes, subjective norms and Perceived Behavioural Control (PBC). Due to data that were not normally distributed, behavioural intention was dichotomised into high behavioural intention and low behavioural intention. A logistic regression analysis was used to test the relationships between the behavioural intention and the TPB variables.

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, X2 (5, N=229)= 21.5, P<0.05. Results showed that attitudes (Odds Ratio= 3.86, 95% Confidence Interval= 2.07-7.20, P<0.05) and subjective norms were the significant predictors of nurses' high behavioural intentions. However, PBC (Odds ratio 1.30, 95% CI= 0.81-2.09, P>0.05) was not.

In conclusion, the findings of this study support the usefulness of the TPB model in predicting nurses’ intentions to comply with a pre-operative skin preparation policy. The results could be used to develop effective intervention strategies based on the nurses' beliefs that underpin their behavioural intention to comply with hospital guidelines and policies. However, future research can confirm the result of this study and expanding the list of contextual variables.

More information

Identifiers

ORCID for David Voegeli: orcid.org/0000-0003-3457-7177

Catalogue record

Export record