S36-45_mahidol 18 | Self-Improvement | Motivation

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Factors Related to Performance Effectiveness of Dental Nurse in Primary Care Unit in the Northeastern Part of Thailand Saowaluk Wijaranaphiti MSc*, Peera Krugkrunjit MSc (Bios.)**, Bhusita Intaraprasong PhD** * Khamsakaesang Community Hospital, Nakornrajsima, Thailand ** Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, Thailand Objective: To investigate the relationships between job characteristics, motivation, role stress and performance effect
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  S36J Med Assoc Thai Vol. 92 Suppl. 7 2009 Correspondence to: Intaraprasong B, Department of Public Health Administration, Faculty of Public Health, MahidolUniversity, 420/1 Rajavithi Rd, Rachathewi Subdistrict, Bangkok 10400, Thailand. E-mail: phpit@mahidol.ac.th Factors Related to Performance Effectiveness of Dental Nurse in Primary Care Unit inthe Northeastern Part of Thailand Saowaluk Wijaranaphiti MSc*,Peera Krugkrunjit MSc (Bios.)**, Bhusita Intaraprasong PhD** * Khamsakaesang Community Hospital, Nakornrajsima, Thailand ** Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, Thailand  Objective: To investigate the relationships between job characteristics, motivation, role stress and  performance effectiveness of dental nurses in primary care units in the northeastern part of Thailand.  Material and Method: A explanatory cross-sectional study was conducted in 326 dental nurses who wereworking in 310 PCUs of 19 provinces, 220 amphurs in the northeastern part of Thailand were taken as thestudy samples. Data were collected by using questionnaires. Pearson’s Product Moment Correlation wasapplied to test between job characteristic model, motivation, role stress and performance effectiveness.  Results: The analysis showed that there was no relationship between job characteristics model and  performance effectiveness as performing dental task needed ‘dealing with others’ and ‘task significance’.There was a positive relationship between motivation and performance effectiveness at a low level. Role stresswas not related to performance effectiveness; however, when the dental nurse had more stress caused by roleconflict internal standard, several roles and their performance effectiveness was reduced. Conclusion: From the research result, it is necessary to help construct networks of dental tasks and other  public health tasks in obvious forms, for some feedback from agents. Work allocation should be preciselyarranged and professional skill should be determined responsibility. Lastly, recruiting dental nurses with proper characteristics in primary care units in the northeastern part of Thailand is crucial as well.  Keywords: Job characteristics model, Motivation, Role stress, Performance effectiveness The health care reform was implemented tomatch the needs of Thai people and the society. Withan aim to closely provide health care service to theThai, many primary care units (PCUs) have been built.As a result, power and authority regarding healthcareand health security were decentralized. The holisticcare was also set up by a community to continuouslysupport a community itself. In a PCU, health careservices are provided by its staffs (1) . The characteristicsof service in PCUs should be integrated health servicesto fit for all age groups covering the best solution for  basic health problems at both individual and familylevel. Moreover, such service must include curative, promotive, preventive and rehabilitative healthcareactivities for both physical and mental of each person.Another added services such as the controland prevention of communicable and noncommunicablediseases in local area and the prevention of diseasescaused by environment and occupation are provided.In addition, surveillance system in a community,consumer protection regarding food and drugs, includ-ing standard and quality of care are also offered  (2) .Dental Public Health tasks is one of the mainservice that is necessary in PCUs, thus dental nurseswere allocated to PCUs to provide dental care at primarylevel. These cares includes encouraging people to jointhe process of dental care, dental health promotion,oral disease control and prevention. Dental nurse  J Med Assoc Thai 2009; 92 (Suppl 7): S36-45 Full text. e-Journal: http://www.mat.or.th/journal   J Med Assoc Thai Vol. 92 Suppl. 7 2009S37  refers to a person who finished and hold certificate of dental nurse, provided by the Sirindhorn Public HealthCollege, Ministry of Public Health. He or she musthave knowledge and skill to provide dental careand services to children aged less than 14 years (3) .Autonomous Performances of dental nurses under the Dental Act, BE. 2539 are 1) dental prevention2) emergency Dental therapy 3) dental therapy and 4) gum treatment by scaling (4) . Dental nurses workingin a PCU need to integrate all dental tasks by usingtheir skill and knowledge to carry out their work covering the main target in a unit and its networks.Some PCUs had a full-time dental nurse with thesupport for resource and budget from communityhospitals or the secondary health facility. As a result, adental nurse must work on his/her own from the firststep until the last one. A proper decision making isneeded and some factors affecting their performanceeffectiveness should be assessed.To enhance PCUs on performing the completeand effective roles according to people’s needs in localarea, the ratio of dental staffs per population must notless than 1:10,000. The ratio of total working time for dental staffs to encourage people to join oral careactivities should be three-fifths. The rest two-fifths of working time should be for oral disease control and  prevention. During transformation period, in the areawhere dental staff is lacking, the ratio of dental staffs per population should not less than 1: 20,000 (coveringall population under responsibility of PCUs in thesecond type). In this case, the healthcare team should  be developed to have effective potential in providingoral care-encouraging people to effectively join dentalhealth promotion. Therefore, the dental staffs will spend four-fifths of the total time to perform oral diseasecontrol and prevention. The rest one-fifth is spent for assisting or supporting the health promotion team (5) .Most dental nurse had been working for 1-2years or less. Working in a PCU where there was nodental team as in a Community hospital and lacking of experiences in providing dental care, can caused dental nurses to feel unconfident doing their work and feel insecure with their career advancement comparingto a Community hospital.Most dental nurses were responsible for alldental tasks and other public health tasks. They need to be responsible for the tasks of other 2-4 Tombonsnearby such as School-based oral health program,mobile dental service, training, and providing dentalservice in different Tombons. Except from DentalPublic health, 72.2% of them had to do other jobswithin health centers such as being in charge, havingresponsible villages and providing dental care to suchvillages, administrating paper work, and giving generaltreatment. For this point, it was easily seen that dentalnurses lacked of experiences so they could not perform their roles smoothly (6) .Other assigned tasks did not fall within thescope of dental nurses’ duties, thus they unavoidablyfelt uncomfortable and unconfident to perform suchtasks. Moreover, inexperience in providing other  public health tasks, the dental nurse may make an error that has a negative impact to an individual or even toan organization at last.The competence of dental nurses who wereworking in PCUs consisted of abilities to performdental condition, to promote oral health, dentaldisease control & prevention, and dental treatment.This work needs professional skills at a high to thehighest level (7) . Moreover, providing dental service inPCUs is necessary and dental staffs cannot denythis work. Sometimes dental nurse have to providecomplicated dental service under control of a dentist ineach PCU. This is a conflict between real practice and the regulations prescribed by the Ministry of PublicHealth regarding dental tasks under control of a professional dentist, BE, 2539.From literature review about related researches,the researcher found that work characteristics, motiva-tion and role perception were related to work  performance. The ambiguous and role conflict wasnegatively related to quality of work, overload and outcomes. The researcher had considered to use somevariables affecting work outcomes-job characteristicsmodel, motivation and role stress (8-12) . As a result, thevariables in this study include independent variables(motivation according to Maslow’s Hierarchy of Need theory, role stress and job characteristics model) and the dependent variables (performance effectiveness).Thus, this present study aimed at analyzing thefactors related to performance effectiveness of dentalnurses in PCUs in the northeastern part of Thailand,on the hypothesis that Job characteristics model and motivation were a high level of positive correlation to performance effectiveness of dental nurse in PCUsand role stress was negatively related to performanceeffectiveness of dental nurses in the northeastern part of Thailand. Material and Method A explanatory cross-sectional study wasconducted in 326 dental nurses who were working in  S38J Med Assoc Thai Vol. 92 Suppl. 7 2009 310 PCUs of 19 provinces, 220 amphurs in the north-eastern part of Thailand were taken as the studysamples. Questionnaire constructed by the researcher was divided into 5 parts as follows:Part 1   questionnaire about performanceeffectiveness was measured by using 4 levels of rating scale are as follows: 4 points = strongly agree...1 points = strongly disagree. The questionnaire of TJ.Delong was adapted  (13) and was used as researchinstruments. The questionnaire was composed of 44 questions. Performance effectiveness means a levelof work results according to a person’s technical/functional competence, autonomy, service, identity,variety, managerial competence, security, and creativity.Briefly, the eight career anchors mean the following: 1)Technical competence. Your organization, your career around the challenge of the actual work you’re doing.2) Autonomy: You value freedom and independence.3) Service: You’re concerned with helping others or working on an important cause. 4) Identity: You’reconcerned with status, prestige, and titles in your work. 5) Variety: You seek an endless variety of newand different challenges. 6) Managerial competence:You like to solve problems and want to lead and control others. 7) Security: You want stability and career security. 8) Creativity: You have a strong need to create something of your own.Part 2 was about role stress caused by roleconflict and role ambiguity. 7 levels of rating scale wereused to measure level of stress. The role-evaluationform of John R. Rizzo, Robert J. House, and Sidney I.Lirtzman (14) was adapted to be a research instruments.It covered 30 items. The scoring criteria are as follows:7 points = very false … 1 points = very true.Part 3 was about motivation (security &safety ,physiological & safety needs, belongingness,affiliation & acceptance (social needs), esteem and self actualization), it was measured by using 6 levels of  basic need or 6 rating scales. The need evaluation formconstructed by Cliff F. Grimes (15) was adapted and used as a research tools. It was multiple-choice questionscovered 24 items. Scoring criteria are as follows: 6 points= strongly agree… 1 points = strongly disagree.Part 4   was about job characteristics model(skill variety, task identity, task significant, autonomy,feedback from job itself and feedback from agents) itwas measured by using 7 levels of rating scale. Thequestionnaire on Job Diagnostic Survey of Hackmanand Oldham (16) was applied. Only one choice wasselected, scoring criteria are as follows: 7 point = thelowest, 4 points = moderate and 1 point = the highest.As can be seen from the formula, a very lowscore on either autonomy or feedback will reducethe overall MPS of the job very substantially. Onthe other hand, a low score on one of the three jobcharacteristics that contribute to experienced mean-ingfulness cannot by itself, seriously compromise theoverall motivating potential of a job.Part 5   was about demographic characteristicsof the samples such as age, sex, educational level,change of work, income, duration of being in thecurrent position and duration of working in the PCUs.Three experts of Dental Public Health Sectionhad examined the questionnaire for its completenessof the content, clarity of language and relevance of issues. Some corrections were made based on the provided suggestions. The questionnaire was tried out in Saraburi and Sa Keaw province, with dentalnurse who had similar characteristics to the study population. The reliability was measured by Cronbach’sAlpha Coefficient. The reliability of each instrumentsare as follows: performance effectiveness = 0.86, rolesstress = 0.73, motivation = 0.71 and job characteristicsmodel = 0.66.Data were analyzed by descriptive statisticssuch as frequency and percentage which were applied to describe demographic characteristics of dental nursein primary care units. Pearsons’ Product MomentCorrelation was applied to test relationship between job characteristics, motivation, role stress and perfor-mance effectiveness of dental nurses in primary careunits. The statistical significance level was set at a =0.05. To consider level of relationships, criterion set byMunro and Page (17) was used. It was classified into 5levels as follows:Alpha coefficientLevel of relationships0.00-0.25Low0.26-0.49Rather low0.50-0.69Moderate0.70-0.89High0.90-1.00Very high Results The questionnaires were sent to 326 samplesin 310 PCUs of 19 provinces in the northeastern part. Atotal of 194 questionnaires or 59.50% were returned and used for data analysis. Motivative Potential Score (MPS) =(Skill Variety + Task Identity + Task Significance) x Autonomy x Feedback 3   J Med Assoc Thai Vol. 92 Suppl. 7 2009S39  Demographic C   haracteristics of dental nurses Results about demographic characteristics of the samples in Table 1 showed that most respondents(61.34%) aged between 25-29 years, followed by 20-24years (24.22%) and > 35 years (7.73%). Most of themheld Dental nurse certificates or diploma (50.51%),followed by bachelor degree or equal (46.91%), and master degree (1.03%). The rest was still studying for  bachelor and master degree (1.55%). Most respondentshad not changed their position (98.96%). However, afew of them used to be dentist assistants (1.03%).More than half of them had been in the position of dental nurse for 4-6 years (54.64%), followed by 7-9years (21.13%) and 1-3 years (12.89%) and more than10 years (11.34%) respectively. About a half wereworking in PCUs for 4-6 years (51.55%), followed by1-3 years (38.66%) and 7-10 years (9.79%).  Performance effectiveness, role stress, motivation and job characteristics Performance effectiveness Most respondents thought that ‘Service’was the most important (M = 3.39). As the crucialcharacteristics of dental tasks was serving the other  by using interpersonal relationship. Other peopleinduced to enhance useful skills. A total performanceeffectiveness of dental nurses was a high level (M = 3.16,SD = 0.42). Among 8 aspects of dental performance,the dental nurse perceived ‘Service’ as a first keyelements, followed by creativity, variety, managerialcompetence, technical competence, autonomy, identityand security respectively (Table 2).  Role stress The average of role stress (role conflict and role ambiguity) from the highest to the lowest wasshown in Table 2. The dental nurses had stresscaused by role conflict more than role ambiguity.When considering by items, it was found results asfollows:  Role conflict: most respondents felt uncertainabout this issue (55.20%), followed by ‘Slightly true’(28.40%) and ‘Slightly false’ (13.90%) respectively.The total score of opinion was at the ‘Slightly false’to ‘Slightly true’ (97.42%). The average score was at‘Uncertain’ (M = 4.13, SD = 0.71).  Role ambiguity: it was found that most of them showed the opinion of ‘Uncertain’ (56.20%),followed by ‘Slightly false’ (30.40%), ‘Slightly true’(7.70%) and ‘Mostly false’ (5.70%) respectively. Thetotal of opinion level was at ‘Slightly false’ to ‘Slightlytrue’ (94.33%). The average opinion ranged from‘Slightly false’ to ‘Uncertain’ (M = 3.66, SD = 0.70).  Motivation The analysis of dental nurses’ motivation inTable 2 was presented from the highest to the lowestmean. It showed that the respondents had need on‘Self actualization’ at a high level-most of their opinionwas at the level of ‘Moderately agree’ (44.33%),followed by ‘Strongly agree’ (32.99%), ‘Tend to agree’(32.99%), ‘Tend to disagree’ and ‘Moderately disagree’(1.55%) respectively. The total opinion was at‘Moderately agree’ to ‘Strongly agree’ level (77.32%).The average opinion was at ‘Moderately agree’ level(M = 5.00, SD = 0.87). It means that the dental nursesdesired to reach ‘Self actualization’. Most of themneeded to fully exploit their competence. They learned about self value from their experience and would likethese evidences to be repeated.  Job characteristics Job characteristics of the dental nursesclassified by item are shown in Table 2. It was found  Demographic characteristics n%Age (years)20-24 4724.2225-2911961.3430-34 13 6.7035-40 6 3.09> 40 9 4.64EducationCertificates (Dental Nurse)/Diploma 9850.51Bachelor Degree or equal 9146.91Master Degree/Equal/Higher 2 1.03Right now studying Master degree 2 1.03Right now studying Bachelor degree 1 0.52Having changed work position No19298.96Yes 2 1.03Duration of being in current position (years)1-3 2512.894-610654.647-9 4121.13>10 2211.34Duration of working at PCU (years)1-3 7538.664-610051.557-9 17 8.76>10 2 1.03 Table 1.  Number and percentages of Dental Nurses’Demographic characteristics (n = 194)
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