The influence of professional competency, professional commitment, and nursing organizational culture on the person-centered practice of nurses in long-term care hospitals: A cross-sectional study

1. The Need for the Research

As the establishment of long-term care hospitals became active in Korea with an increase in the older adult population, the number of long-term care hospitals increased more than 13 times from 113 in 2004 to 1,461 in 2022 [1]. However, there has been growing public interest in the person-centered care practice in long-term care hospitals as questions have been raised about the treatment of patients and the quality of care despite this quantitative expansion in long-term care hospitals. The person-centered care practice refers to perceptions and practices of respecting the values and abilities of the care recipients and providing care to protect human autonomy, independence, and self-esteem, with individualized care as the fundamental principle [2]. Globally, it has been reported that the person-centered care practice reduces nurses' stress and burnout, increases job satisfaction and quality of care [3-5], improves participants' physical function and activities of daily living [6], and reduces depression and helplessness [5]. In Korea, the person-centered care practice was also found to positively affect improving the quality of care in long-term care hospitals [7].

McCormack [8] presented the conceptual framework for older adults to promote the person-centered care practice. Based on this, McCormack and McCance [9] expanded the conceptual framework for the person-centered care practice targeting various medical care providers. According to the conceptual framework of McCance and McCormack [10], the quality of care providers should be considered as a prerequisite to providing the person-centered care practice, and expected results can be reached effectively through the person-centered care practice process when a care environment for delivering the person-centered care practice is established. Care providers' qualities include professional competence, which refers to the knowledge, skills, and attitudes of health care providers who provide holistic care, interpersonal skills, beliefs, and values, as well as professional commitment to patients and families [10]. In addition, for these qualities to be fully realized, nurses must be able to deliver the person-centered care practice through the care environment, which is the context and culture of providing care. This care environment includes systems that support shared decision-making, shared authority, effective employee relations, a supportive organizational structure, the possibility of innovation and risk-taking, and the physical environment [9,10].

Previous research has reported factors that influence the person-centered care practice, such as care competence [11], self-leadership [12], and empowerment [13]. These factors are similar to professional competence and interpersonal skills among the qualities of care providers as identified by McCormack and McCance [9] in their framework for the person-centered care practice, and care competence can be said to be an encompassing concept. Care competence improves the efficiency and quality of medical care [14] and can therefore be essential in implementing the person-centered care practice in long-term care hospitals. In addition, since nurses at long-term care hospitals need professional duties and responsibilities for providing care for older adults [15], professional commitment as nurses is particularly required. In addition, previous research has reported that nurses' work environment [16] and innovation-oriented care organizations' culture [17] influenced the person-centered care practice. Care organizations’ culture refers to the behavioral patterns, norms, and expectations that affect the thinking and behavior of care organizations' members [18], which may motivate the person-centered care practice and a care environment that promotes the process [10].

In this regard, care competence, job commitment, and care organizations' culture, presented in the conceptual framework of McCormack and McCance [9], are presumed to be critical factors of the person-centered care practice in long-term care hospitals. Still, empirical research on them is hard to find. Until now, research on the person-centered care practice in Korea has mainly focused on nurses in general hospitals [17]. Some research on nurses in long-term care hospitals has been conducted piecemeal, such as a survey on nurses' perceptions of person-centered care [19] and a correlation analysis [7] of person-centered care and quality of care services.

Therefore, to promote the person-centered care practice in long-term care hospitals, it is necessary to comprehensively identify the factors affecting the person-centered care practice based on the conceptual framework and seek practical measures. As such, based on McCormack and McCance [9], this research aims to understand the impact of care competence, professional commitment, and care organizations' culture in long-term care hospital nurses on the person-centered care practice. The study findings will be important primary data for establishing a direction to promote the person-centered care practice in the future.

2. Research Purpose

The specific purpose of this research is as follows.

1. To identify long-term care hospital nurses’ care competence, professional commitment, and care organizations’ culture and level of the person-centered care practice;

2. To identify differences in the person-centered care practice according to the general characteristics of long-term care hospital nurses;

3. To examine the correlation between long-term care hospital nurses’ care competence, vocational commitment, care organizations’ culture, and the person-centered care practice; and

4. To examine the impact of long-term care hospital nurses’ care competence, vocational commitment, and care organizations’ culture on the person-centered care practice.

1. Research Design

This research is a descriptive correlation study to identify care competence, job commitment, care organizations’ culture, and the person-centered care practice level targeting long-term care hospital nurses and to survey the effects of long-term care hospital nurses' care competence, job commitment, and care organizations' culture on the person-centered care practice.

2. Participants

For data collection for this research, among the long-term care hospitals with more than 200 beds in Daegu City and Kyeongsang Province, three specialized hospitals for older adults operated by cities and provinces and four long-term care hospitals operated by private owners were randomly selected. Long-term care hospitals with more than 200 beds were selected as data collection sites because the Patient Safety Act and the Healthcare Act require hospitals with more than 200 beds to have dedicated personnel for patient safety and medical quality improvement. Nurses working in long-term care hospitals who understood the purpose of the research and agreed to participate in the survey were selected as a convenient sample.

Participants were nurses who provided care to patients in the seven long-term care hospitals; however, those on leave were excluded. Based on previous research that indicated new nurses experience difficulty performing nursing for their first year after graduation [20], this research targeted nurses working at long-term care hospitals for more than 12 months. With a significance level of .05, a median effect size of .15, a test power of .90, and nine control variables and six predictors in hierarchical multiple regression test using the G*Power program (University of Dusseldorf), the sample size required a minimum of 124 people. In this research, data were collected from 133 people considering dropout, and a total of 131 people were included as the final sample, excluding two questionnaires with insufficient responses.

3. Ethical Considerations

This research was approved by the Institutional Review Board of Kyungpook National University (KNU-2021-0004). For the ethical consideration of this research, the researcher obtained consent by emailing or verbally explaining to the participants who contacted the researcher after reading the recruitment announcement and provided a copy of the written consent form to participants while complying with the hospital infection rules due to COVID-19. During the consent process, the researcher explained that the data collected would be kept confidential and used only for research purposes. Participants could discontinue participation at any time during the research if they did not want to continue without penalty.

4. Measures

1. General Characteristics of the Participants

Table 1 shows the general characteristics of the participants. The average age of the participants was 44.42±11.22 years, with 51 (38.9%) being in their 50s or older, followed by 38 (29.0%) being in their 40s, 24 (18.3%) being in their 30s, and 18 (13.7%) being in their 20s. Fifty-six participants (42.7%) were religious, and 95 (72.5%) were married.In the educational level, 64 (48.9%) had a Junior college, 62 (47.3%) had university, and five (3.8%) had a Graduate school and over. As for the participant's salary satisfaction, 73 (55.7%) indicated moderate, 50 (38.2%) were dissatisfied, and eight (6.1%) were satisfied. As for current positions, Staff nurses accounted for 100 (76.3%), and head nurses accounted for 31 (23.7%). The average clinical career of the participants was 13.11±7.99 years, and the average working experience in long-term care hospitals was 6.29±4.96 years. Eighty-six participants (65.6%) had experience in nursing for older adults (Table 1).

Table 1.

Person-centered Care According to General Characteristics (N=131)

2. Participant’s Care Competence, Job Commitment, Care Organizations’ Culture, and Person-centered Care Practice

Table 2 shows the participant's care competence, professional commitment, care organizations' culture, and person-centered care practice level. The participant's care competence was an average of 4.77±0.84 on a scale of 1 to 7. Of subdomains, documentation and administration of nursing care scored the highest at 4.88±0.98, followed by medical and technological care at 4.81±0.85, value-based nursing care at 4.78±0.97, nursing care at 4.72±0.81, Development, leadership, and organization of nursing care at 4.68±1.03, and care pedagogics at 4.67±0.91. The participant's professional commitment averaged 4.27±0.89 on a scale of 1 to 7. The average score of the subdomains of the participant's nursing organizational culture was the highest for the relationship-oriented culture at 3.69±0.65, followed by the hierarchical-oriented culture at 3.37±0.55, innovation-oriented culture at 3.29±0.60, and work-oriented culture at 3.00±0.59. Finally, the participant's person-centered care practice level averaged 3.45±0.44 on a scale of 1 to 5. By subdomain, comfort care scored the highest at 3.87±0.53, followed by knowing the person at 3.62±0.49, working with older adults at 3.54±0.57, personality at 3.52±0.59, management structure at 3.45±0.56, support relationships at 3.22±0.66, and autonomy at 2.89±0.74 (Table 2).

Table 2.

Person-centered Care, Professional Competency, Professional Commitment, and Nursing Organizational Culture among the Nurses in Geriatric Hospitals

3. Person-centered Care Practice According to the General Characteristics of the Participant

Person-centered care practice showed statistically significant differences according to age (F=2.86, p=.040), satisfaction with salary (F=3.45, p=.035), and job position (t=-2.55, p=.012). The person-centered care practice was higher in participants in their 50s or above than in those in their 30s, in head nurses (vs. staff nurses), and when they were satisfied with their salary. The person-centered care practice of the participants did not differ according to religion, marital status, educational level, hospital clinical career, long-term care hospital clinical career, or elder nursing education experience (Table 1).

4. Correlation Between Participant’s Care Competence, Job Commitment, Care Organizations’ Culture, and Person-centered Care Practice

Table 3 shows the analysis result of the correlation among the participants’ professional competence, professional commitment, nursing organizational culture, and person-centered care practice. Participants' person-centered care practice was significantly positively correlated with professional competence (r=.66, p<.001) and professional commitment (r=.35, p<.001). Person-centered care practice was positively correlated with innovation-oriented culture (r=.65, p<.001), relationship-oriented culture (r=0.46, p<..001), and task-oriented culture (r=.46, p<.001) among nursing organizational culture, but was not correlated with hierarchical culture (r=.22, p=.011). Participants' professional competence was significantly positively correlated with innovation-oriented culture (r=.56, p<.001), relationship-oriented culture (r=.54, p<.001), task-oriented culture (r=.42, p<.001), and hierarchical culture (r=.28, p<.001) among the nursing organizational culture. Participants' professional commitment was significantly positively correlated with work-oriented culture (r=.43, p<.001), hierarchical culture (r=.33, p<.001), innovation-oriented culture (r=.32, p<.001), and relationship-oriented culture (r=.30, p<.001) among the nursing organizational culture. Also, professional competence and professional commitment were positively correlated (r=.41, p<.001) (Table 3).

Table 3.

Correlations Among Person-centered Care, Professional Competency, Professional Commitment, and Nursing Organizational Culture

5. Effects of Participant’s Care Competence, Job Commitment, and Care Organizations’ Culture on Person-centered Care Practice

Table 4 shows the results of the hierarchical analysis to identify the effects of the participants’ professional competence, professional commitment, and nursing organizational culture on person-centered care practice. In the hierarchical analysis 1-step model, satisfaction with salary was a significant influencing factor (β=.19, p=.031) on person-centered care practice, and the explanation power was 8.6% (F=3.03, p=.008). In the hierarchical analysis 2-step model, including professional competence and professional commitment and controlling age, salary satisfaction and job position, professional competence was a significant influencing factor (β=.59, p<.001) on person-centered care practice. As a result, the explanation power of the model increased to 43.7% (F=13.61, p<.001). In the hierarchical analysis 3-step model, including nursing organizational culture for each subdomain and controlling age, salary satisfaction, job position, professional competence, and professional commitment, the innovation-oriented organizational culture was a significant influencing factor (β=.36, p<.001) on person-centered care practice. The explanation power of the model was 52.5%, and the additional R² was 9.7% (F=12.97, p<.001). Care competence, which was significant in the model 2, was still a significant influencing factor (F=5.38, p<.001) on person-centered care practice. In other words, the higher the professional competence and the stronger the perception of the innovation-oriented culture within the nursing organizational, the more positively person-centered care practice was found (Table 4).

Table 4.

Hierarchical Regression Analysis on Factors Influencing on Person-centered Care