Knowledge, attitudes and practices of nurses towards assessment using performance reports in a Free State sub-district
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Performance assessment reports are distinct to most well-established organisations and companies that strive to utilise their human resources for the benefit of growth and development. Moreover, understanding about employees’ knowledge, attitudes and practices regarding their duties of concern is fundamental to their compliance to rules of the companies they serve. However, in spite of the seemingly valuable contribution that the Performance Report, as part of the Performance Development and Management System, can make to improve the quality of service delivery in the Free State province, it seems that neither nurses nor supervisors are entirely comfortable with this assessment process. Rating scales and the consequences of receiving a specific rating seem to cause dissatisfaction among staff. The aim of the study was to assess the knowledge, attitudes and practices of nurses towards assessment, using a performance report in public hospitals in Maluti-A-Phofung municipal area. The study followed a descriptive quantitative research approach. Approval to conduct the study was obtained from Health Science Research Ethics Committee of the Faculty of Health Sciences of the University of the Free State, and the Free State Department of Health. Three hospitals in Maluti-A-Phofung (one regional hospital and two district hospitals) were selected for the study. All nurses who were not on any type of leave and who were not part of management formed the study sample (n = 187). Participants completed a self-administered questionnaire. The predesigned KAP (knowledge, attitudes, and practices) questionnaire was based on Ajzen’s theory of planned behaviour (TPB). Frequencies and percentages for categorical data were used as part of the descriptive statistics. Participants were professional nurses (n = 119; 63%), enrolled/staff nurses (n = 21; 11.1%) and enrolled nursing auxiliary/assistant nurses (n = 49; 25.9%). The knowledge component was discussed based on behavioural and normative beliefs and subjective norms. The behavioural beliefs of participants were likely to predict positive attitudes towards performance assessments. Normative beliefs ranging from 87.3% to 98.4%, according to TPB (grounded on what significant others/other nurses believe), should influence participants’ assessment-related behaviours positively, while subjective norms were closely aligned to normative beliefs of other nurses. Statements projecting subjective norms overwhelmingly predicted positive performance-assessment-related behaviours. Participants’ control beliefs were assessed based on self-development opportunities as an example of control they may/may not be able to exert in their particular circumstances. In this case, the results implied that participants could not assert much control over engagement in self-development opportunities. In relation to participants’ perceived behavioural control, the researcher focused on factors that may assist participants to develop professionally and factors that would prevent them from developing professionally. The findings of the study imply that factors that seemed to impact on participants’ professional development were based on lack of resources, and managerial constraints. Regarding participants’ attitudes, the median (83.3%; n = 157), within a range of 16.7% - 100%, influenced specific behaviour (participants’ attitudes influenced specific behaviour as implied by the median and the indicated range). This implied that participants had generally positive attitudes towards performance-assessment-related behaviours, in spite of negative attitudes towards the need to place patients’ needs before their own. Practices were assessed based on intention, actual behaviour and behaviour. Concerning intentions, most participants had very strong intentions to act out certain performance- assessment-related behaviours, despite their low intentions regarding personal development. Regarding the actual behaviour, the median percentage leading to behaviour was 100% (range: 0 – 100%), which implies that participants had strong positive perceptions regarding practical means to act out certain behaviours related to performance-assessment reports, even though it is interesting that a lower score was seen on the issue related to involvement in self-development programmes. The results of participants’ past behaviours suggest that they have been able to carry out behaviours related to performance reports, however, they experience some difficulty in carrying out behaviours related to participation in in-service training for self-development. The recommendations of the study are packaged in tables that delineate the information related to the KAP of participants in relation to the components of the TPB. Specific statements of interest from the questionnaire were selected to structure the recommendations (for example, behavioural beliefs: maintenance of patient hygiene, assistance with elimination process; normative beliefs: monitoring of administration of medications; subjective norms: operation of all relevant apparatus and equipment; control beliefs: seeking learning opportunities; attitude: serving the public in an unbiased and impartial manner in order to create confidence in the public service; intention: seeking learning opportunities such as in-service-training courses; actual behaviour and behaviour: seeking learning opportunities such as in-service training, commitment through timely service to the development and upliftment of all South Africans). The findings of the study lead to recommendations that are specific to the provincial management of the Free State Department of Health and institutional management, to institute periodic job compliance by monitoring and reinforcing in-service training, and to establish posts for clinical facilitators for different specialty areas at institutions.