Professional self-efficacy and motivation of pediatric hospital staff in the patient-centered medical care system

Relevance

The modern healthcare system is undergoing a transition from the traditional paternalistic model to a patient-centered approach, where the patient and their family are actively involved in the medical decision-making process. In pediatric practice, this transformation is significant because working with children and their families places increased demands on the emotional, communicative, and deontological competencies of specialists. The professional self-efficacy of medical workers acts as an important psychological resource determining the quality of medical care delivery. Despite a considerable number of studies devoted to individual aspects of the professional activity of medical workers, a comprehensive study of the relationship between self-efficacy and motivation of pediatric hospital staff in the context of a patient-centered approach remains an insufficiently explored area.

The methodological basis of this study was formed by the results of 20 scientific works, including 4 systematic meta-analyses, devoted to the issue of self-efficacy, professional motivation, and the patient-centered approach.

Professional self-efficacy represents the medical worker's belief in their own ability to successfully perform professional tasks. Research shows that self-efficacy acts as a psychological buffer mediating the impact of adverse work factors on the quality of professional activity: in a study by Hendy A. et al., it was found that self-efficacy significantly mediates the relationship between workload and key professional competencies, protecting specialists from the destructive influence of stress [1]. Data obtained in a study by Rafiei S. et al. demonstrated the moderating role of self-efficacy in the relationship between occupational stress and mental health disorders in nurses [2]. Zhou C. et al., in an international comparative study, revealed that physicians with high patient-centered self-efficacy demonstrate better abilities in managing chronic diseases [3]. The combination of high moral sensitivity and self-efficacy, established by Mousazadeh N. et al., forms the basis for implementing patient-centered care [4]. Filatova Yu.S. and Solodchuk O.N. found that physicians with more developed emotional regulation and empathy skills are characterized by higher self-efficacy and motivation to adhere to ethical norms [5]. Khokhlov A.L. and Sychev D.A. defined the patient-centered approach, where the patient's needs, values, and preferences are at the center of the treatment process [6], which is particularly important in pediatrics as it requires considering the interests and opinions of the child, their parents, or legal representatives.

In the context of pediatric practice, the study by Du Y. et al. is of particular importance, as it demonstrated a positive correlation between emotional self-regulation and self-efficacy [7]. In a study by Liao H. et al., it is described that pediatric practice is associated with increased [stress/burden? The original Russian text seems incomplete: "с повышенной, в связи с чем исследователи отнесли..." – likely meaning "with increased stress/burden, which is why researchers classified..."], which is why the researchers classified pediatric nurses as a high-risk group for developing professional burnout [8].

The structure of professional motivation of medical workers includes intrinsic and extrinsic components. A systematic review by Veenstra G.L. et al. showed that intrinsic motivation is associated with the quality of medical care and work behavior [9]. A meta-analysis by Li L.Z. et al. demonstrated that nurse burnout is associated with low quality and safety of medical care [10]. Bernales-Turpo D. et al. confirmed that professional self-efficacy is positively related to work engagement and life satisfaction, while simultaneously reducing the risk of burnout [11]. These data indicate that work engagement may act as a mediator between self-efficacy and professional functioning. Moreover, self-efficacy is a dynamic characteristic that transforms during the process of professional activity.

The patient-centered model of medical care delivery, based on partnership between specialists and patients, and their families, implies the involvement of all participants in the decision-making and treatment planning process. Systematic reviews by Gustavsson K. et al. revealed that providing patient-centered care increases job satisfaction among medical professionals when there is organizational support, effective teamwork, and recognition from patients [12]. Crawford L. et al., in a systematic review devoted to factors facilitating and hindering patient-centered goal-setting in rehabilitation, established that involving patients in the goal-setting process improves their confidence, motivation, and satisfaction with treatment outcomes [13]. Vishnyakova V.A. described the principles of implementing a patient-centered approach in primary healthcare [14], Solodchuk O.N. and Pavley L.V. – in a pediatric hospital setting [15]. Kapustina T.V. examined patient-centeredness as a model for planning and evaluating medical services in the context of contemporary Russian medicine [16].

Pavley L.V. and Solodchuk O.N. described that the life-meaning orientations of pediatric faculty students and their implicit intelligence correlate with the readiness to apply these principles in practice [17].

In a series of studies, Kashapov M.M. and Solodchuk O.N. established that the development of creative thinking and the ability for non-standard solutions is associated with an increase in the professional self-efficacy of medical workers [18, 19]. The authors also described that with increasing experience, specialists more often rely on internal motives and values, which contributes to more effective communication with children and their parents. Filatova Yu.S. and Solodchuk O.N. considered creativity as a resource ensuring adaptability and sustainable motivation of medical personnel [20].

Objective

To study the specifics of self-efficacy and motivation of medical workers (physicians and nurses) depending on experience in the context of a patient-centered approach. The following hypotheses were formulated: 1) there is a relationship between work experience and the level of self-efficacy among medical workers; 2) there are significant differences in the level of self-efficacy and motivational structure between nursing staff and physicians, as well as between medical workers depending on work experience.

Materials and methods

The pilot study involved 33 respondents. The first group consisted of 17 physicians from pediatric hospitals in Yaroslavl, average age 38.1±0.4 years. The second group consisted of 16 nurses from pediatric hospitals in Yaroslavl, average age 38.1±0.7 years.

To achieve the study's objective, a set of psychodiagnostic methods was used. The "Self-Efficacy Test" (D. Maddux, M. Scheer, modified by L. Boyarintseva under the supervision of R. L. Krichevsky) allowed assessing two key aspects of self-efficacy: the level of self-efficacy in objective activity, reflecting confidence in professional skills and competence, and the level of self-efficacy in interpersonal communication, characterizing the ability to effectively build social contacts and manage interpersonal situations. Herzberg's "Motivational Structure Test" was applied to study the intrinsic and extrinsic motivational factors of professional activity. The method allows assessing the significance of various aspects of work: material reward, recognition, relationships with management, job content, responsibility, opportunities for career growth, achievements, and teamwork. To assess the patient-centeredness of medical workers, an original questionnaire was developed, based on the key principles of the patient-centered approach in healthcare.

Statistical data processing was carried out using the Statistica 10 software package. To identify significant differences between groups, the non-parametric Mann-Whitney U-test was used; to study relationships between variables, Spearman's rank correlation coefficient was used. The level of statistical significance was set at p < 0.05.

Results

The results of the survey using the original questionnaire showed that both study groups demonstrated a high level of awareness of the importance of applying the basic principles of patient-centeredness, including effective communication and ethical interaction with patients in the pediatric hospital and their parents. Maximum active involvement in activities was noted by 42% of respondents, moderate involvement – by 54%. 58% believed they explain information about the treatment process to the patient in an accessible form. 67% of respondents noted high importance for themselves of the emotions experienced by patients, 23% – moderate importance. Only 30% of respondents were absolutely sure they could handle conflicts arising in professional activities; the rest noted moderate ability. 67% of workers were convinced they maximally consider the individual age characteristics of patients, 25% – moderately consider this factor. The majority of respondents try to create a comfortable environment for patients, with physicians demonstrating higher results on all parameters of patient-centeredness compared to nurses.

The study of the motivational structure of physicians and nurses working in children's hospitals showed that "A (money)", "B (recognition)", "D (relationship with management)", "H (job content)", "C (responsibility)", and "I (teamwork)" in both groups are within close values. It can be assumed that in the motivational structure determining the professional activity of physicians and nurses, material reward and recognition, relationships with management and job content, as well as responsibility and teamwork play a relatively similar role.

As a result of statistical analysis, significant differences were identified on the scales of the motivational structure test "E (career)" and "F (achievements)" between the groups of nurses and physicians (see table). Within the framework of Herzberg's two-factor theory of motivation, both positions relate to intrinsic, motivating factors. Based on the results obtained, it can be concluded that opportunities for career and professional growth are more important for nurses, while for physicians – achievements; it is important for them to feel success, competence, completeness, and significance from the work performed.

Table. Intergroup differences in indicators of the motivational structure of medical workers according to the Herzberg F. method (Mann-Whitney U-test)

To identify statistically significant differences in the motivational structure of medical workers with longer and shorter work experience, the non-parametric Mann-Whitney U-test was also applied. Significant differences between groups were found only on scale B (recognition) (U = 66.00, Z = -2.08, Z = -2.09, p=0.04). Recognition motivation as an extrinsic factor plays a greater role in the motivational structure of medical workers with longer work experience. Thus, it is more important for them to receive positive evaluation and recognition for a job well done compared to young specialists. Experienced specialists feel a natural need for confirmation of the value of their accumulated experience and professionalism. Furthermore, recognition may compensate for the decline in other aspects of professional satisfaction, for example, the accumulation of physical and emotional fatigue associated with the intensive nature of work in a pediatric hospital, and the gradual routinization of professional activity. In these conditions, recognition from management and colleagues becomes an important supportive factor, helping to maintain professional motivation and prevent the development of professional burnout.

As a result of a comparative analysis of groups of medical workers differing in work experience, as well as nurses and physicians, using the "Self-Efficacy Test" by Maddux and Scheer modified by Boyarintseva under the supervision of Krichevsky, no significant differences were identified. The "Level of self-efficacy in objective activity" and the "Level of self-efficacy in interpersonal communication" in both groups are within close values. It can be stated that there is relatively equal confidence in professional skills, one's competence, ability to control the course of events and influence results in objective activity, regardless of the duration of the medical workers' professional activity. The ability to effectively build and maintain social contacts, achieve goals through interaction with other people, and manage interpersonal situations is diagnosed to approximately the same extent in individuals with long and short work experience.

The results obtained using correlation analysis revealed a different system of correlations in the studied groups. Thus, positive correlations were proven in the "Physicians" group: between the physician's age and the scale in the motivational structure "A (money)" (r = 0.521), as well as scale D (relationship with management) (r = 0.539). Thus, it can be noted that the older the physician in a children's hospital, the more importance they attach to financial factors in professional activity. With increasing age, physicians value the quality of relationships with management (objectivity of assessment, support) more. Negative correlations were found in the "Physicians" group: between the physician's age and the scale in the motivational structure "H (job content)" (r = -0.613). The older the physician, the less the activity matches professional interests. It can be assumed that reasons might be professional burnout, routine, or a change in priorities. There is a correlation (r = -0.480) between the physician's age and the scale "C (responsibility)". With age, motivation for responsible work performance decreases. A positive correlation was found between the scale in the motivational structure of the physician's personality "D (Relationship with management)" and work experience (r = 0.497). The longer the experience, the more important positive relationships with management are for the physician. A negative correlation was found between work experience and "H (job content)" (r = -0.543). The longer the physician's experience, the less significant job content becomes for them.

Analyzing the correlations between perceived self-efficacy and motivational structure in pediatric hospital physicians, a positive correlation can be highlighted between the scales "Level of self-efficacy in interpersonal communication" and "B (recognition)" (r = 0.393). Physicians with a high level of self-efficacy in interpersonal communication expect more recognition for a job well done from colleagues and management.

The results obtained from the correlation analysis of the motivational structure and level of self-efficacy in the group of nurses illustrate a somewhat different picture of relationships. Positive correlations were identified in the "Nurses" group: a strong correlation between age and motivation "E (career)" (r = 0.735). The older the nurses, the more important opportunities for career and professional growth are for them. It can be assumed that with age and accumulation of experience, nurses may have an increasing need to confirm their status through career opportunities. A strong correlation was also found between work experience and motivation "E (career)" (r = 0.779). The longer a nurse's work experience, the higher the importance of career growth for them. A significant correlation exists between the scales "Level of self-efficacy in objective activity" and the scale in the motivational structure "A (money)" (r = 0.337). The higher the nurses' confidence in their professional skills, the higher the significance of financial motives. It can be assumed that nurses confident in their competence expect material reward for their work. The correlation between the scales "Level of self-efficacy in interpersonal communication" and motivation "E (career)" (r = 0.325) shows that the higher the nurse's level of self-efficacy in interpersonal communication and ability to manage social situations, the higher the significance of career growth for them. Communication skills are an important resource for career advancement, and awareness of this resource may enhance motivation for growth in this category of medical workers.

The results obtained from the correlation analysis of the motivational structure and level of self-efficacy among medical workers with long and short work experience show the following. Presence of a negative correlation in the group "Medical workers with long work experience" between age and motivation "H (job content)" (r = -0.594). For medical workers with long experience, the factor of the job content itself (interest, creativity, alignment with personal interests) becomes less important for their job satisfaction. It can be assumed that a long career in medicine, especially in difficult conditions, can lead to signs of professional burnout: exhaustion, decreased interest in the substantive side of work. A positive correlation in the group "Medical workers with short work experience" between the scales "Level of self-efficacy in interpersonal communication" and motivation "A (money)" (r = 0.527). The higher the perceived self-efficacy in interpersonal communication of a young specialist in communicating with colleagues, patients, and management, the higher the significance of the financial factor in professional activity for them. A negative correlation between age and "Level of self-efficacy in interpersonal communication" (r = -0.630) demonstrates that the younger the employee, the higher their confidence in their abilities for interpersonal communication. A negative correlation between the scales "Level of self-efficacy in interpersonal communication" and motivation "I (teamwork)" (r = -0.476). The more confident a medical worker with short work experience is in their communication skills, the less important working in a cohesive team and a comfortable climate is for them. It can be assumed that young specialists rely more on their own strengths and perceive teamwork as a less significant factor.

The identified differences in the motivational structure of physicians and nurses confirm the importance of a differentiated approach to personnel management in medical institutions. The greater importance of achievements for physicians correlates with the results of studies by Veenstra G.L. et al., which showed that intrinsic motivation is associated with the quality of medical care and work behavior [9]. The high importance of career growth for nurses reflects the objective limitations of career opportunities in this professional group and can be seen as a request for creating a system of professional advancement for nursing staff.

The increasing importance of recognition for experienced specialists is consistent with the data from Gustavsson K. et al. on the role of organizational support and recognition from patients in preventing professional burnout and increasing job satisfaction [12]. The decrease in the importance of job content with increasing experience can be considered a sign of professional burnout, which is confirmed by the results of Li L.Z. et al. on the link between nurse burnout and low quality of medical care, and indicates the need to develop burnout prevention programs for experienced specialists [10]. The absence of significant differences in the level of self-efficacy between groups may indicate that self-efficacy is a relatively stable characteristic formed in the early stages of professionalization, which is consistent with the data from Bernales-Turpo D. et al. on the role of professional self-efficacy as a predictor of work engagement [11].

Conclusion

The conducted study reveals the complex motivational structure of the personality of physicians and nurses with short and long work experience. Among the motivational factors of their professional activity, there are both extrinsic motives (material reward, recognition, relationships with management, and teamwork) and intrinsic factors of the motivational structure (job content, responsibility, achievements, and career). The factor of age and work experience plays a role in the structure of motivation and perceived self-efficacy of nurses and physicians. Physicians and nurses working in children's hospitals are aware of the importance of patient-centeredness, including effective communication, and creating a comfortable and supportive environment for the patient.

Physicians attach greater importance to the feeling of success, competence, and significance of the work performed. With age, the importance of material reward and relationships with management increases for them, while the importance of job content and responsibility decreases. Physicians with high self-efficacy in interpersonal communication expect more recognition from colleagues and management.

Nurses attach importance to career and professional growth, which increases with experience. The higher the nurses' confidence in professional skills, the more important material reward is for them, and high confidence in communication skills enhances the importance of career growth.

For medical workers with long work experience, recognition is more significant. Young specialists demonstrate higher confidence in interpersonal communication. At the same time, high communicative self-efficacy in young employees reduces the importance of teamwork and increases the importance of material motivation.

Thus, self-efficacy is a central psychological resource linking organizational conditions, personal characteristics of medical workers, and key quality indicators of patient-centered care in a children's hospital.