|Year : 2022 | Volume
| Issue : 1 | Page : 62-70
Dedication in nursing: A concept analysis
Raheleh Sabetsarvestani1, Emine Geçkil1, Zahra Hadian Shirazi2
1 Department of Paediatric Nursing, Faculty of Nursing, Necmettin Erbakan University, Konya, Turkey
2 Department of Nursing, School of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
|Date of Submission||07-Jun-2021|
|Date of Decision||30-Aug-2021|
|Date of Acceptance||21-Sep-2021|
|Date of Web Publication||23-Mar-2022|
Zahra Hadian Shirazi
Department of Nursing, School of Nursing and Midwifery, Namazi Square, Shiraz 71936-13119
Source of Support: None, Conflict of Interest: None
Background: Dedication is one of the components of professional nursing. However, no clear consensus exists on the definition of dedication in nursing, and it is difficult to understand and operationalize this concept in clinical settings. Objectives: This study aimed to analyze the concept of dedication in nursing. Methods: This concept analysis was done using the hybrid model from February to June 2021. In the theoretical phase, the existing literature on dedication in nursing was reviewed in international databases of PubMed, Science Direct, ProQuest, Ovid, and Scopus. The keywords were “dedication” and “nursing”. After excluding duplicate and irrelevant records, 34 documents were reviewed. In the field phase, semistructured interviews were conducted with six nurses to gather new qualitative data on their experiences of dedication. In the integration phase, the findings of the earlier phases combined to provide a comprehensive definition of the concept. Content analysis was used to analyze the data. Results: Dedication in nursing was defined as a feeling and state of mind and heart, like an untiring commitment that is the art and essence of nursing. It is caring from one's heart with all human beings and technical resources available, doing beyond regular work hours and organizational and legal duty. This act usually happens without expectation for any reward or incentives in such a way that may lead to neglecting one's own needs. Conclusion: This concept analysis can be a good guide for nurses, teachers, and managers to know the meaning of dedication and recognize how to breed the spirit of dedication in nursing and prevent its negative consequences.
Keywords: Concept analysis, Dedication, Hybrid model, Nursing, Professionalism, Qualitative research
|How to cite this article:|
Sabetsarvestani R, Geçkil E, Shirazi ZH. Dedication in nursing: A concept analysis. Nurs Midwifery Stud 2022;11:62-70
| Introduction|| |
Throughout history, many people have dedicated themselves to saving the lives of others. Florence Nightingale dedicated herself to nursing and pursued it until the last moment of her life. Also, history confirmed the role of nurses in World Wars I and II, and their dedication is undeniable. After that, nurses have always played an important role and have been on the front lines in natural [e.g. floods and earthquakes] and man-made disasters [e.g. wars, pollution, nuclear explosion, and fires]. The World health organization declared COVID-19 as a global pandemic on March 11, 2020. During this pandemic, despite the stressful work that exhausted them physically and mentally, nurses have shown a spirit of dedication. Even in this tough situation with masks, face shields, gowns, gloves, and social distancing, nurses provided compassionate care to help patients recover from the virus. In this situation, nurse managers were proud of nurses due to their bravery, dedication, and teamwork. Nowadays, dedication in nursing is becoming more important due to significant factors such as the development of the COVID-19 pandemic, the global shortage of nurses, political resolution to curb the growth of healthcare costs, and the medical error rate that threatens the patients' health. Raatikainen believed that nursing is a calling and an experience. She explained that a calling is a deep desire to dedicate oneself to serve humans based on professional values. Nurses who experience it have a good understanding of patients' needs, work skillfully and are highly motivated to care proficiently for patients. Dedication is also one of the components of professional nursing.,
A review of the literature confirms the effects of individual and organizational factors on dedication in nursing. Ebrahimi et al., in a qualitative research, showed that dedication was part of the nurses' ethical behaviors during decision-making processes. They explained that some of the nurses' characteristics such as faith in having the right performance, understanding, empathy, altruism, and moral sensitivity are related to dedication. These characteristics may make nurses more sensitive to the patients' needs. They may even overlook their own basic needs. Jenaro et al. reported that 33% of nurses experienced high dedication. Heggen et al. studied the role of background variables in nurses' dedication behaviors and found that gender, work-related experiences, and parent's education level could contribute to dedication. Another study confirmed that the working environment can affect the nurses' job satisfaction and turnover intention; that finally affect the quality of their services and their dedication behaviors. Von Bogaert et al. also declared that dedication as one of the work engagement aspects depends on how the environment supports nursing team.
A review of the literature shows that no clear consensus exists on the definition of dedication in nursing. So, it is hard to understand and operationalize this concept in the clinical setting. Therefore, further studies are needed in this area.
This study was conducted to analyze the concept of dedication in nursing to provide a better understanding of the definition, antecedents, and consequences of the concept, especially during the outbreak of COVI-19.
| Methods|| |
Design and participants
This concept analysis was done from February to June 2021, using the hybrid model introduced by McEwen and Wills. This model consists of three phases namely theoretical, fieldwork, and final analytic phases. The theoretical phase reviews the present works in the concerned area, provides a definition of the intended concept, and creates the context for in-depth analysis and redefinition of the concept in the next phases. In the fieldwork phase, new qualitative data are usually collected and analyzed to strengthen and refine the definition provided in the first phase. The third phase combines the findings of the theoretical and fieldwork phases.
The theoretical phase
An online search was conducted in international databases including PubMed, Science Direct, ProQuest, Ovid, and Scopus. The keywords for searching were “dedication” and “nursing”. Articles published from 2000 to 2020 were searched. The eligibility criteria were the inclusion of the keywords in the article, English language, relevance to the study subject matter, and access to the full text of the article. In total, 417 articles, including letters to the editors, were retrieved. After excluding duplicates and irrelevant records, 34 quantitative and qualitative studies were included [Figure 1]. Content analysis was conducted using the Graneheim approach. Maxqda10 software was used to organize the data. The articles were read several times to find and code the words and phrases related to dedication in nursing. Then, the codes were integrated, categorized, and summarized into categories that represented the antecedents, attributes, and consequences of dedication in nursing.
The fieldwork phase
Face-to-face, semistructured interviews were conducted to collect qualitative data from nurses who were purposefully selected from the educational hospitals affiliated with Shiraz University of Medical Sciences. The inclusion criteria were having rich experience of dedication in nursing and willingness to participate in the study. An expert assistant professor with more than 6 years of experience in qualitative research and more than 22 years of experience in nursing did the interviews. The participants were asked to report their experiences and perceptions of dedication, its antecedents, and consequences. The interview was started with “how do you define dedication?” and continued with “in what nursing conditions did you have a feeling of dedication?”, “how did dedication affect you physically and emotionally?”, and “what strategies can help to improve dedication in nursing? In case of any need for further clarification, we asked follow-up questions such as “can you provide an example?”, “may you please provide a further explanation?”, and “what did you mean by this?” Each session was held in a silent room at the nurses' workplace after the shiftwork by considering the precautions for controlling the transmission of COVID-19. The interviews lasted for 55 minutes, on average, and were recorded with the participants' consent. The interviews continued until no new conceptual code was obtained. All in all, six nurses were interviewed. All nurses were females; their mean age was 34.16 years and their mean work experience was 11 years. Data analysis started at the same time as the data collection procedure. The Graneheim content analysis method was used to analyze the data. The interviews were transcribed and frequently reviewed to obtain their main ideas and recognize the meaning units (i.e., words, phrases, and paragraphs with conceptual meanings related to dedication). Then, words and phrases related to dedication in nursing were coded and similar codes were grouped to form the main categories and subcategories. These categories were clustered into main themes.
Final analytic phase
The findings of the previous phases were compared and combined to provide a definition and determine the antecedents and consequences of dedication in nursing.
The four criteria of credibility, dependability, conformability, and transferability were used to enhance the trustworthiness of the findings. Credibility was ensured using constant comparison, prolonged engagement with the data, and member checking. For member checking, the transcripts of the interviews and codes extracted of them were returned to the related participants to be checked. Dependability was maintained by peer checking of the coding and categorizing process. Transferability was maintained by providing detailed descriptions of the participants' experiences and characteristics, study context, barriers, and limitations. To ensure confirmability, all phases of the study were documented, so that other researchers can audit the study process.
The Vice-Chancellor of Research of Shiraz University of Medical Sciences approved the study and the National Code of Ethics No. IR.SUMS.REC.1399.1271 was received. Written informed consent, and permission to record the interviews were obtained from all participants. The aim and method of the study were explained to the nurses. They were informed that their contribution to the study was voluntary and the withdrawal was possible at any time. The precautions related to COVID-19 were considered during all interviews.
| Results|| |
The findings of the theoretical phase
The Cambridge dictionary defined dedication as the willingness to give a lot of time and energy to something because it is important. Based on the Oxford dictionary, dedication can be defined as the hard work and effort that somebody puts into an activity or a purpose because she/he thinks it is important. This word first appeared in the 14th century as a name for the solemn act of dedicating something, such as a calendar day or a church to a divine being or to a sacred use. The attributes, definition, antecedents, and consequences of dedication in nursing based on a review of the texts are summarized in [Table 1]. According to the results of our literature review, dedication is related to the high job commitment, together with the manifestation of a feeling of significance, pride at work, and inspiration. Dedication refers to being strongly involved in one's work and experiencing a sense of significance, enthusiasm, inspiration, pride, and challenge. Also, according to Shwu-Jiuan, caring is dedication.
|Table 1: Determining the attributes, definition, antecedents, and consequences of dedication in nursing based on the literature review|
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The attributes of dedication in nursing
Dedication attributes can be categorized into internal and external manifestations. Internal manifestations include feelings and states of mind and heart about the career such as having a purpose, responsibility, pride, courage, motivation, absorption, untiring commitment, being convinced and satisfied that are the art of nursing and stable over time. External manifestations include helping, listening, accompanying, caring, focusing, perceiving, adopting, arranging, paying attention, affording, dispensing, involving, and considering.,
The antecedents of dedication in nursing
The antecedents of dedication in nursing were categorized under personal, interpersonal, job-related, and contextual factors. Personal factors include sex [women showed higher dedication],, younger age, knowledge, experience, faith, fairness, tolerance, tendency toward empathy, altruism, moral sensitivity, perceived calling, creativity, communication skills, spiritual and ethical values, and trust [organizationally, managerially, and collegially]. Interpersonal factors include having a positive and supportive relationship with peers, seniors, teachers, mentors, managers, coworkers, supervisors, physicians, patients, and family members. Job-related factors include permanent employment, job control, career progression, positive job-related feedbacks, autonomy, task variety, task significance, clarity of expectations, reasonable workload, job satisfaction, good appearance in the job, belief in having the right performance, task identity, pay rise, satisfaction with job position, reward system, job resources, job stressors, adequacy of the workforce, and job insecurity. Contextual factors are divided into environmental and developmental factors. Environmental factors include quality of working life and organizational features. Developmental factors include providing opportunities for developing skills, learning, progressing and growing, and career counseling. This can be achieved by regularly discussing the views and expectations, and trying to find mutually acceptable and achievable goals.
The consequences of dedication in nursing
The consequences of dedication in nursing are divided into positive and negative ones. Positive consequences are related to nurses, patients, and organizations. For nurses, positive consequences of dedication include experiencing a high quality of life, self-nurturance [healthy lifestyle choices], physical and psychological well-being, family-related well-being, perceived quality of working life, satisfaction, lower social dysfunction, lower stress associated with patient care, and feelings of significance, motivation, and being proud of pursuing this career. For organizations, positive consequences of dedication by nurses include reduced hospital mortality rates, higher financial profitability of organizations, satisfaction with organizational policies, positive job outcomes management, increase in the nurses' intention to stay, and managers' satisfaction. For patients, positive consequences of dedication by nurses include protecting, preserving, promoting the patients' health, improving the perceived quality of care, and enhancing a family's sense of coherence. Negative consequences are related to the physical and psychosocial health of nurses. In nursing, the negative consequences of dedication include overlooking their own basic needs, physical harm or injury, health problems, susceptibility to the harmfulness of the job environment, and burnout. Negative psychosocial health consequences include excessive stress, role ambiguity, work challenges, more negative job attitudes, reaction to stressful job situations, susceptibility to job insecurity, parental stress, family conflict, and difficulties in maintaining non-work-related relationships.
The findings of the fieldwork phase
In total, 430 primary codes were generated and categorized into three main categories of attributes, antecedents, and consequences of dedication in nursing.
The attributes of dedication in nursing
The attributes of dedication in nursing were grouped into six subcategories namely, the essence of nursing, caring with love, doing beyond the duties, overlooking one's needs, caring without expectation, and considering the patient as a family member.
The essence of nursing
Nurses believed that dedication is an inherent part of the nursing profession. A participant said: “Nursing and dedication are inseparable. If a nurse does not have a spirit of dedication, it will be difficult and sometimes impossible for him/her to stay in the profession.”
Caring with love
The participants believed that dedication makes nurses care with love. A nurse highlighted that: “Caring with dedication means providing comprehensive qualified care from the bottom of your heart by focusing on communication and respect without considering the patients' background.”
Doing beyond your duties
According to our participants, a dedicated nurse usually works beyond his/her duties. A nurse said: “You usually have to work unceasingly beyond shift hours to satisfy the patients' needs; even you may work instead of your colleague or accept to work beyond your duty hours in crisis or holidays.”
Overlooking one's needs
Participants believed that a dedicated nurse might usually overlook his/her own needs and try to meet the patient's needs. A participant explained: “In some cases, I even forget to drink a little water. For example, during the COVID-19 epidemic, although we knew that this situation was very dangerous for our health and our family, we came to work and continued caring for the patients.”
Caring without expectation
The analysis showed that dedicated nurses provided care without any expectation. A nurse commented: “When we care, we don't have any expectation from our patients and their families, we are not looking for any reward, we just think about helping others and alleviating their pain.”
Considering the patient as a family member
According to the participants, dedicated nurses usually consider patients as their family members and they companionably provide care for them. A nurse said: “A dedicated nurse is a person who does some procedures that even the family members are reluctant to do. These nurses consider their patients as their own brother or sisters and look after them with care.”
The antecedent of dedication in nursing
The result of the content analysis showed that the antecedents of dedication in nursing were specific personality traits and background, supportive work environment, and education.
In this regard, a nurse explained: “A dedicated nurse is usually honorable, sacrificial, patient, forgiving, kind, and faithful with God. Also, culture, religion, and family education level and background can have an essential role in the development of dedication in a nurse.”
Regarding the role of the supportive environment, another nurse explained: “A supportive work environment with a good job division, without role ambiguity, and with qualified supervision and incentives can provide a good environment for encouraging dedication.”
Regarding the role of education, another participant said: “In my opinion, having a good role model such as a dedicated teacher, colleague or manager can play an influential role in the development of dedication in nursing. These characteristics cannot be taught in theoretical courses and just manifests themselves in practice.”
The consequences of dedication in nursing
According to the participants, dedication in nursing had positive consequences for the nurses, patients, and the profession. About the positive psychosocial consequences of dedication for nurses, a nurse said: “When you care for your patient dedicatedly and with the highest standard, you receive positive feedbacks that positively affect your life. You would be satisfied and would have a good feeling with a sense of comfortable conscience.” Another nurse stated: “A dedicated nurse can positively influence others. He/she would be a role model and others and encourage others to improve the spirit of dedication.”
The positive consequences of dedication in nursing for patients include increasing the satisfaction of patients and their families and decreasing the length of hospital stay. In this regard, a nurse said: “When a patient receives care from a dedicated nurse, his/her bio-psycho-social health improves, leading to preventing complication and increasing satisfaction.”
Finally, dedication in nursing can have positive consequences for the nursing profession. In this aspect, a nurse confirmed that: “… a dedicated nurse promotes the profession, by changing the views of the society about the nursing profession. Then, nurses would be encouraged to stay in this profession. Many nurses will then be encouraged to continue their education at postgraduate level, which consequently can facilitate the progression of the nursing profession.”
The nurses' definition of dedication in nursing
According to our participants, we can conclude that dedication is the essence of the nursing profession and includes providing comprehensive qualified care from the bottom of the heart by focusing on communication and respect without considering the patients' background. It means caring with love and doing beyond our duties, and without expecting a reward. A dedicated nurse usually overlooks his/her own needs and takes care of patients as their own family members.
The result of the integration phase is summarized in [Table 2]. This phase combines the findings of theoretical and fieldwork phases. Accordingly, dedication—as the essence of nursing—can be defined as: “an untiring commitment to take care of others from one's heart with all the human and technical resources available and doing beyond regular work hours and organizational and legal duties. This act is usually happening without expecting a reward or incentive and is usually accompanied by neglecting the one's needs.”
|Table 2: Constructs of dedication in nursing according to the theoretical, fieldwork, and integration phase of the study|
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| Discussion|| |
The present study attempted to clarify the concept of dedication in nursing. Our findings lead to determining the attributes, antecedents, and consequences of dedication in nursing. Nowadays, dedication is more necessary in nursing than before due to the increase in different crises like pandemics, wars, and other natural disasters. Also, the shortage of nurses and the high rate of job burnout in this profession highlighted the importance of promoting the spirit of dedication in the nursing profession., Wynd et al. explained that positive domains of nursing must be recognized and highlighted to retain nurses in the profession and attract young students to nursing as a career. According to our results, nursing and dedication are inseparable and dedication is one of the most important behavioral characteristics of a good nurse. Our result is consistent with those of Shwu-Jiuan who explained that caring is dedication. Therefore, it is necessary to breed this characteristic in our nurses and students. Our findings showed that providing a good role model is an efficient way for developing dedication in nursing students. The role model can be a teacher in a university, a good colleague or peer in a hospital, or an inspiring manager. Heggen et al. confirmed that a good teacher–student interaction had a positive effect on cultivating the spirit of dedication in nursing students. Another important factor for cultivating dedication in nursing is a supportive environment. Based on our result, managerial supports and providing opportunities for skill development, learning, career counseling, can not only increase the nurses' job satisfaction but also promotes the spirit of dedication in nurses. The occurrence of such outcomes can also be facilitated through the improvement of the nurses' employment status, autonomy, and working conditions. Our result is similar to those of Von Bogaert et al. who reported that work setting can influence the staff's job satisfaction, turnover intentions, and dedication. Interpersonal communication is another influential factor in improving dedication in nursing. Van Bogaert et al. also reported that dedication is not just a personal experience but can be shared and transferred in a group. Dedication as a work engagement aspect appears to be dependent on how work setting support nursing teams in their daily practice. Furthermore, a good relationship between health care teams, especially nurses and physicians, can encourage the spirit of dedication in nurses. Given the associations between social relationships in the workplace and dedication, it is recommended to implement more training programs in communication skills to increase dedication in the workplace. According to our analysis, dedication in nursing may have both positive and negative consequences for the nurses, patients, organization, and profession. Apart from positive consequences, such as improving quality of care and patient satisfaction, it can decrease the time of hospitalization that may lead to a decrease in the costs. Also, by increasing the patients' satisfaction, we can change the view of society and other members of the health care team toward the nursing profession. Ebrahimi et al. also reported that nurses can help protect, preserve, promote, and improve the health of their patients through dedication. Considering the consequences of dedication, it seems like a double-edged blade that on one side, has positive consequences for nurses, but on the other edge, it has negative consequences if they are exaggerated. Thus, it is important to educate our nurses to maintain the extremes and not overlook their own needs or organizational rules, which may harm them and their profession. In order to decrease the negative consequences of dedication in nursing, we should provide good role models to convey the appropriate meaning of dedication in nursing, balance it toward positive consequences, and decrease its negative effects for nurses. Also, other strategies such as designing stress management programs, offering job rewards, providing constructive feedback, selecting and introducing a dedicated nurse every month, and granting regular vacation programs are useful., According to our results, dedication and nursing are inseparable and a dedicated nurse needs to be patient, kind, forgiving, honorable, and courageous. Therefore, before selecting nursing as a profession, a nursing student needs to acknowledge and get familiar with the special attributes and prerequisites of a nurse to select his/her future job consciously. Wu et al. confirmed the importance of this fact and recommended that nursing institutions should provide more platforms to help school graduates better understand the nursing profession. Furthermore, admission interviews might be partially effective in drop-outs in the nursing profession. This concept analysis was limited in some ways. We had limited access to databases and full-text of articles; thus, we could only use the available resources. Also, we just searched for articles published in the last 20 years in five databases. Therefore, further studies should be conducted on nurses and in a variety of cultures to develop a scale for assessing dedicated nurses.
| Conclusion|| |
The results of this study led to the definition of dedication in nursing and clarified its antecedents, attributes, and consequences. This concept analysis could be a good guide for nurses, teachers, and managers in this profession to know the meaning of dedication and understand how to increase the spirit of dedication in nursing and prevent its negative results. Our findings could be utilized to promote retention in the nursing profession, especially during the 21st century with the epidemic of COVID-19 by implementing strategies to improve organizational and individual variables for improving dedication in nursing.
The authors would like to thank the nurses who participated in this study. Also, they would like to thank the Vice Chancellor for Research who has financially supported this project, and the Health Policy Research Center of the Shiraz University of Medical Sciences. This grant has been registered with the code of national ethics IR.SUMS.REC.1399.1271.
Financial support and sponsorship
This study was granted by the Health Policy Research Center of Shiraz University of Medical Sciences.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]