Journal of Modern Medical

Introduction
Psychological empowerment refers to intrinsic task motivation of people and providing platforms and creating opportunities for flourishing their talents, abilities and competencies. Evidence shows that psychological empowerment can have a positive effect on nurses’ behavior and lead to positive outcomes, such as organizational health (OH) which shows the ability of an organization to function effectively. Perception of OH in hospitals can facilitate the proper implementation of nursing programs. On the other hand, healthy organizations have employees with high organizational commitment (OC). Psychological empowerment can affect the OC of employees, and it can be reciprocally affected by OC. The OC refers to a strong belief in the values and goals of the organization, a sense of loyalty to the organization, and a desire to remain a member of the organization. Nursing managers should continuously assess the psychological ability, OC, and OH of nurses to ensure the quality and safety of nursing care. This study aims to evaluate the relationship of psychological empowerment of nurses with their OH and OC.

Methods
This descriptive, cross-sectional study was conducted in 2021 in a hospital affiliated to the social security organization in Kerman, Iran. The study population includes all nurses working in this hospital (n=253). All nurses were included in the study by census method. The criteria for entering the study were at least 6 months of clinical work experience and no psychological problems according to self-report. Exclusion criterion was the return of incomplete questionnaires. The data collection tools were a demographic form, the psychological empowerment scale (PES) of Spreitzer, the organizational commitment questionnaire (OCQ) of Allen & Meyer with 22 items‚ and organizational health inventory (OHI) of Hoy & Feldman with 44 items and 7 subscales. The Persian version of PES was validated by Ghanbari and Shamshadi. Its reliability using Cronbach’s α coefficient was reported 0.87. The Persian version of OHI was validated by Azami and Falahi. The Persian version of OCQ was validated by Khodadadi and Salehi (2018). Its Reliability using Cronbach’s α coefficient was reported 0.79. SPSS software, version 24 was used for performing data analyses. At first, data distribution normality was tested using Kolmogorov-Smirnov test. Descriptive tests (frequency, percentage, Mean±SD and independent t-test, one-way analysis of variance, Pearson’s correlation test and multivariate regression analysis were used for data analyses. The significance level was set at 0.05.

Results
Most of the participants were 36-45 years old (43.6%), female (56.4%), married (78.2%), with a bachelor’s degree (71.6%), more than 10 years of work experience (52.9%), and working in obstetrics and gynecology and emergency departments (17.3%). The mean total score of PES was 59.82±8.24 (moderate). The highest score was related to the meaning dimension ( 13.32±1.75) and the lowest score was related to the trust dimension (10.36±2.50). The mean total score of OHI was 151.10±18.56 (high). The highest score was related to the administrative level dimension (72.08±10.86) and the lowest score related to the institutional level dimension (21.45±3.38). The mean total score of OCQ was 76.41±8.05 (moderate). The highest score was related to the continuance commitment dimension (26.52±3.15) and the lowest score was related to the normative commitment dimension (24.48±2.90). Pearson’s correlation test showed that the psychological empowerment of nurses had a significant and direct relationship with their OH (r=0.6, P=0.001) and OC (r=0.45, P=0.001). The results obtained from multivariate regression analysis showed that psychological empowerment of nurses had a significant effect on their OH and OC (P<0.05) where 35% of changes in OH and 20% of changes in OC were explained by psychological empowerment.

Conclusion
The psychological empowerment score of nurses in the study hospital is at a moderate level. They had the highest score in the meaning domain and the lowest score in the dimension of trust. These results indicate that although the nurses had a high sense of meaning, they had a lower sense of trust in the current issues of the hospitals. The OH of nurses in the study hospital is at a high level while their OC is at a moderate level. In OH, the highest score was at the administrative level and the lowest was at the institutional level. This indicates that the nursing manager’s influence at the administrative level has the greatest relationship with the effectiveness of the hospital and shows the importance of this domain in determining OH level. In terms of OC, nurses had the highest and lowest scores in the continuance and normative commitment dimensions, respectively. This indicates that the nurses’ staying in the hospital is not due to their sense of obligation or emotional attachment. Those with a continuance commitment remain in the organization because they feel that they will lose more by leaving than they will gain. Nursing managers in the study hospital are recommended to mostly use reward methods to increase the psychological empowerment and OC of nurses and maintain or increase their OC. They should try to create and maintain a healthy work environment and consider justice and fairness in policy- and decision-makings.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Kerman University of Medical Sciences (Code: IR.KMU.REC.1399.682).

Funding
This paper was derived from a master's thesis of Jamile Farokhzadian, approved by Kerman University of Medical Sciences (Code: 99001128). 

Authors' contributions
Conceptualisation, methodology, supervision: Sedigheh Khodabandeh Shahraki; Design and statistics: Jamile Farokhzadian; Data collection: Zahra Sadeghi; Review and editting: Sedigheh Khodabandeh Shahraki and Zahra Sadeghi.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to express their gratitude to the hospital management and all the nurses of the Payambar Azam Hospital who helped us in conducting this research.
 

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