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Table of Content Volume 8 Issue 3 - December 2018

Investigating the relation of trustworthy leaders and mental health with optimism of personnel of amiralmomenin burns hospital of Shiraz

 

Farzaneh Pishahang1, Parviz Aghayii Barzabad2*, Abbas Yazdanpanah3

 

2,3Assistant Professor, 1Department of Healthcare Management, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran

Email: aghaieparv@gmail.com

 

Abstract               The above study has been conducted with the aim of investigating the relation of trustworthy leadership and mental health with optimismpersonnel of Amiralmomenin burns hospital of Shiraz. The present study is of descriptive-correlational type. The statistical population of this study includes all personnel of Amiralmomenin burns hospital of Shiraz City that using convenient sampling method, 196 employees of Amiralmomenin burns hospital of Shiraz were selected as sample. The research instrument includes mental health questionnaire (GHQ), trustworthy leadership style questionnaire and optimism questionnaire. For data analysis in this study, SPSS 21 software and descriptive and inferential statistical methods (Pearson correlation factor and step by step regression analysis) have been used. The obtained results showed that trustworthy leadership style has a significant positive relation with mental health and optimism. Also, there is a significant relation between trustworthy leadership and mental health in personnel of Amiralmomenin burns hospital of Shiraz. The results of multivariate regression analysis showed that trustworthy leadership style and mental health has the ability to predict optimism changes.

Key Word: trustworthy leadership, mental health, optimism, Amiralmomenin burns hospital of Shiraz

 

 

INTRODUCTION

Intense competition of the organizations for retaining survival and remaining safe from economic latency and bankruptcyis along with uninterrupted effort for acquiring success and profit in the world level and in this path, manner of guiding personnel and the organization by the leaders has a very high significance. Leadership has been defined as influencing a group for achieving agreed goals (Appelbaum et.al, 2004 quoted from Sadeghi et.al, 2015). Leadership style may have twofold impacts on attitude, motivation and occupational performance of personnel so that appropriate performance and positive features of a leader like justice, being moralist and supporting personnel have positive and formative impacts on personnel and on the contrary, negative features and specifications of a leader like injustice and not being moralist and intention to needs and desires of personnel may have a negative and destructive impact on personnel attitude and performance (Yilmaz, 2010). Personnel has the right to work in an organization where they are respected and considered, are well understood and also feel mutual trust, honesty, loyalty and that they are a part of the organization. The leader who creates such an environment with these specifications, is a leader whose behaviors should reflect morality and trust and who is loyal to ethical values and follows moral rules which express honesty, effort for doing the best and being loyal in all moments (Mcmamus, 2010). So, in this study, this variable has been addressed. Modern psychology tries not to divert all its attention to mental problems and mostly emphasizes the positive aspects of life. According to Sligman and Mihali (2000), positive psychology goal is to accelerate the psychology center of gravity, so that besides addressing treatment and healing of illnesses, the life quality is also promoted (Sligman et.al, 2000, quoted from Poursardar et.al, 2013). Here, optimism as one of main subcategories of positive psychology approach has been considered among positive aspects of human features that during the last decade have occupied a special site in the domain of evolution psychology, family and mental health psychology. Also, optimism is an attitude which is along with expectation for social or non-social future, that the evaluating person evaluates it according to its demand in social respect (Tiger, 1979, quoted from Kajbaf et.al, 2006). According to Peterson, optimism or positive thinking points the orientation where usually positive consequences are expected and these consequences are considered as stable, general and internal factors (Peterson, 2009). Optimistic people are more social than pessimistic people; enjoy more optimal interpersonal skill, they are sociable and may easily create a supporting social network around them. As it is clear, the pessimistic people more than optimistic people get depressed and less progress in the field of occupation and sport than their talent (Mercola, 2002). One of significant roles of optimism is the rate of impact that it has on people mental health and influences human life in mental, physical and social aspect. Succulence, vivacity and sense of wellbeing are among divine blessing which has been donated to man in the light of mental health and wellbeing. Mental health is one of the most important effective factors in human evolution and promotion. Mental health is an aspect of general concept of health. World Health Organization defines health as: full general state of physical, mental and social health, not just lack of disease or inability (Curtis, 2009, translated by Mohammadi, 2015). During 20th century, more than any other time human faced alteration in respect of living methods, social relations and mental and health problems. Acceleration for getting industrialized and fast extension of urbanism and machine life that its requirement is accepting modern methods for living has had a reverse impact on human health and has risen to health problems. Unorganized social, economic, political and cultural status of the world and burden of social, environmental and mental problems has created many ill-like reactions in people and societies which have caused worsening of situation and unfavorable conditions of environment (Ahmadvand, 2014). History has shown that many prevalent illnesses and mental diseases in advanced and developing countries are the result of factors which are created by the man (Ganji, 2015). So, such factors are preventable. Mental health is an issue which includes all people of the society and its observation is duty of all people of the society (Ahmadvand, 2014). It is for this reason that from the past considering mental health and addressing it has been noticed authorities and it seems that this subject has more possibility of discussion in the future and concerning the machine life. The term mental health is the ability to continue an active and complete and also flexible life against the pressures which occur in life (Alaghehband, 2011). Any person may get involved in mental discomfort since health has not just been limited to explaining reasons of behavioral disorders but its main object is to prevent discomfort occurrence (Shamloo, 2016). Studies have shown that optimistic and positivism attitude in encountering failures improves mental health, while pessimism has a negative impact. Our thoughts increasingly influence our emotional problems. Negative thought are prevalent in negative mood and depression and positive thoughts play a role in good and happy feelings. Negative attitude causes using inappropriate approaches and facing obstacles and mental unrest and low self-respect, stress, anxiety and other issues relating mental health threat (Zeini et.al, 2014). Therefore, the above study was conducted with the aim of investigating the relation of trustworthy leadership and mental health with optimism of personnel of Amiralmomenin burns hospital of Shiraz.


 

METHODOLOGY

The present study is of descriptive- correlational research type. Research time period: this study was conducted in 2018 on all personnel of Amiralmomenin burns hospital of Shiraz. This study was conducted in Amiralmomenin burns hospital of Shiraz. Statistical society of this research includes all personnel of this hospital who were 400 persons. For determining the sample content in this study, Morgan andKarjesi table was used that based on this table and concerning the statistical population of the study, 196 persons ofAmiralmomenin burns hospital of Shiraz have been selected as sample of the above study. For selecting the sample in this study convenient sampling method has been used. For collecting data, the following tools were used:

A: General health questionnaire (GHQ):

This questionnaire which has been made by Goldberg (1998) and is among one of the most known instruments of screening mental disorders is available as forms 12, 28, 30 and 60. In this study, 28 questions form has been used that its questions include four sub scales each by itself includes 7 questions. Questions 6-9 are related to the scale of physical symptoms and general health status. Questions 8-14 are related to anxiety scale, questions 15-21 are related to social performance disorder and questions 22-28 are related to depression scale. There are two types of scoring method for this test. One is the traditional method that the options are scored as 0-0-1-1 and maximum score for the individual will be equal to 28. Another method of scoring is Likert method. Maximum test score with this method in the mentioned questionnaire will be 84 (Heidari, 2016). In this study, Likert method has been used. Also, the obtained methods haven't been recoded and the higher score indicates more mental health. This questionnaire has been standard and has been normalized in various populations in Iran. In a study, this questionnaire was assessed along with a parallel test that the correlation factor of two tests has been 55 and the correlation factors between the subtests of this questionnaire with total score was between 0.72 to 0.87 which indicates its high validity. This study has been conducted on the student statistical population (Ebrahimi, 2005). Also, this test has a high reliability that the alpha rate for all its items is 0.90.

B. questionnaire of trustable leadership style

In the present study, for assessing the trustworthiness of leader in personnel view, trustable leadership questionnaire of Walumbwa et.al has been used. This questionnaire has 16 clauses and 4 components of awareness, clarity in relations, balanced process of information and internalized ethical ideology and for each component, 4 clauses have been considered, the responses to this questionnaire have been scored on 5- grade likert range. The questionnaire reliability factor of trustful leadership has been obtained using Cronbach's alpha method as 0.95% (Avolio et.al, 2009). Sadeghi (2015) has translated and used this questionnaire for the first time in Iran. Also, in the above studies this questionnaire reliability factors has been obtained 0.78 and 0.85 with two Cronbach's alpha method and fifty fifty.

c- Optimism questionnaire

For evaluating optimism in this study, Life Orientation Test has been used. This instrument has been designed by Scheier and Carver (1985) and has 8 questions and evaluate the expectations that an individual has about the life consequences and includes 4 questions with positive terms (like at the time of lack of trust I expect to obtain the best results) and 4 questions with negative terms (like: whenever I think a bad event will occur for me surely that bad event will happen for me). The questions 1, 3, 4 and 7 were positive and were directly scored. The questions2,5,6 and 8 have been negative and scored inversely. The respondents should answer the four-option questions with some degrees ranging from much agree to quite disagree. This scale has followed satisfactory psychometric features and the validity factor of 0.88 was obtained (Marshalland Lang, 1990). In the study of Kajbaf et.al (2006), the above scale alpha factor has been obtained 0.85. for data analysis, in this study SPSS 21 software and descriptive statistical methods (frequency, percent, average and standard deviation) and inferential statistical methods like correlation factor, Pearson, and step by step regression analysis have been used. The research findings Table 1 shows that central and dispersal indicators of trustful leadership style, mental health and optimism.

Table 1: Average and Standard Deviation Of Research Variables

variables

average

standard deviation

number

trustable leadership

52.19

13.78

196

mental health

61.23

11.59

196

optimism

182.65

34.53

196

Contents of table 1 show the descriptive statistical results include average and standard deviation of trustful leadership style, mental health and optimism along with total score.

 

Table 2: Normality test

Test

 kolmogorov smirnov

Shapiro - wilk

variable

statistics

freedom

degree

significance level

statistics

Freedom

degree

significance degree

trustful leadership style

0.1114

190

0.115

0.904

190

0.121

mental health

0.3651

190

0.176

0.915

190

0.250

optimism

0.6880

190

0.081

0.986

190

0.097

Table 2 includes the results of Kolmogorov Smirnov and Shapiro Wilks test that there two tests are used for investigating normality of the study data. In this study, as the results of table 2 shows, the significance level in both tests is higher than the critical rate 0.05 which indicates the null hypothesis confirmation. In the normality of null hypothesis including data follows the normal distribution. Regarding the onfirmation of null hypothesis, this result is obtained that for all research variables, data follows normal distribution. Answer to the research hypotheses Main hypothesis: there is a significant relation between trustful leadership and mental health with optimism of personnel of Amirolmomenin Burns Hospital of Shiraz.

Table 3: correlation factor of trustful leadership and mental health with optimism

varable

 

mental health

Optimism

trustful leadership style

correlation factor

0.276**

0.179*

significance level

0.000

0.12

The results of correlation factor between trustful leadership and mental health with optimism has been presented in the table 3 that the obtained results show that trustful leadership style has a significant elation with mental health and optimism in level 0.01. The research secondary hypotheses: First hypothesis: there is a significant relation between trustful leadership and mental health with optimism of personnel of Amirolmomenin Burns Hospital of Shiraz

 

Table 4: correlation factor of trustful leadership and mental health

variable

 

resilience

trustful leadership

correlation factor

0.235**

significance level

0.000 0

The results of table 4 show that there is a significant positive relation between trustful leadership and mental health in level 0.01. Second hypothesis: there is a significant relation between trustful leadership and optimism with optimism of personnel of Amirolmomenin Burns Hospital of Shiraz

 

Table 5: correlation factor of trustful leadership and optimism

variable

 

death anxiety

trustful leadership

correlation factor

0.22 **

significance level

0.000

In table 5, the results of correlation factor between trustful leadership and optimism in Amiralmomenin Burns Hospital of Shiraz have been presented that the results show that there is a significant and positive relation between trustful leadership and optimism in level 0.01. Fourth hypothesis: trustful leadership and optimism with mental health are significant predictors of optimism in personnel of Amirolmomenin Burns Hospital of Shiraz

 

Table 6: The results of multivariate regression test for predicting optimism through trustful leadership and mental health

Predicting variable

B

SE

β

T

P

R

R2

F

P

general model

 

 

 

 

 

0.277

0.19

8.19

0.001

trustful leadership style

5.41 -

1.57

0.240 -

3.44 -

0.001

 

 

 

 

mental health

1.71 -

1.43

0.083 -

1.19 -

0.234

 

 

 

 

Table 6 presents the results of multivariate regression analysis to predict optimism through a trustful leadership style and mental health. According to Table 4-6, a trustful leadership style and mental health, concurrently account for 19% of the variation of optimism (p <0.01, F=19.8).

 DISCUSSION AND CONCLUSION

Main hypothesis: There is a significant relationship between trustful leadership and mental health with the affection of the staff of Amiralmomenin Burn Hospital in Shiraz. Data analysis has shown that a trustful leadership style has a positive and significant relationship with mental health and goodness at the level of 0.01. The findings of this research are in line with the findings of the researches of Mullakhlyli and Ahmadi (1393), Saberi et al. (2006), Satang et al. (2010), Blair, Lytood, Kenneth, Strauss and Sachs (2008). In the above explanation, it can be said that the World Health Organization (WHO) has a vital need for mental health and is vital for improving the quality of human life. Optimism is one of the structures that have attracted a lot of research in recent years to predict mental health. Optimism, or, in other words, the tendency for good experiences to happen in life, is defined as a relatively stable personality trait that determines the type of person's behaviors. Mental health is necessary to maintain the durability of social, professional and educational performance of the community and to provide it is the main objective of the implementation of mental health programs in the organization. Undoubtedly, the world today is the world of humans and the custodians are different organizations of human beings. Organizations, without human existence, will not only have no idea but their administration will not be possible. On the other hand, the social life of humans requires cooperation, mutual support and fulfillment of needs. This has led to the division of labor and the development of various specialties and skills, and has increased the quantitative and qualitative progress and the effects and results of its development, and has expanded its social and organized relations in the form of institutions, institutions and more or less specialized units, obviously a large part of adult life is spent on work and it seems that activity is considered to be an important activity in terms of mental health. The work, regardless of financing, can address some of the basic needs of a person such as psychological and physical mobility, social contact, self-esteem, trust, and ability (Behnia et al., 2008). Trustful leadership style and behavioral characteristics of a leader can have dual effects on employees' attitude, motivation and job performance, so that proper performance and positive characteristics of a leader such as justice, ethics and employee support, has positive and constructive impacts on employees, and in contrast to the characteristics and characteristics of a leader such as non-ethics and morality, and without paying attention to the needs and desires of employees, it can have negative and destructive effects on employees attitude and practice of employees (Ilmaz, 2010). Employees have the right to feel that they are well-understood in an organization that is considered and respected, as well as mutual trust, honesty, honesty, and being part of the organization; a leader who creates such an environment with these characteristics, The leader is to reflect all his behaviors of morality and trust, to be faithful to ethical values, and to follow moral laws that express truth, endeavor to do best and to be honest at all times (McMemus, 2010). Positive optimism or positive thinking as one of the main elements of the positive psychology approach is considered as a positive person, which during the last decade has a special place in the field of psychology of change, family psychology and mental health. Is a good mood or an attitude that comes with the expectation of a social or non-social future that the evaluator evaluates socially in accordance with his own will (Tigger, 1979; quoted by Kajbaf et al., 2006). One of the important roles of optimism is the extent to which it affects the mental health of individuals and affects human life in a psychological, physical and social context; happiness, joy and happiness are one of the divine gifts, which has been given human health and mental well-being. In addition, mental health is one of the most important factors in the promotion and evolution of human beings. Most research has shown that optimistic and positive attitudes in the face of failures and failures improve mental health. , While pessimists have a negative impact. Our thoughts are increasingly affecting our emotional problems, negative thoughts are common in negative mood and depression, and positive thoughts are involved in good and happy feelings; the negative attitude leads to adopting inappropriate coping strategies and facing barriers and Mental disturbances and low self-esteem, stress, anxiety, and other issues related to mental health threats (Zeinling et al., 2014). The order of the relationship between the above variables is justifiable. The first hypothesis: There is a significant relationship between trustful leadership and mental health in the staff of the Amiralmomenin Burn Hospital in Shiraz Data analysis has shown that there is a positive correlation between trustful leadership and mental health at the level of 0.01. The findings of this study are consistent with the findings of Qadampour (1394), Satang et al. (2010), Blair, Lytood, Kenneth, Strauss and Sachs (2008). In the above explanation, Bennis (1988) suggests three criteria for mental health: 1. Adaptability and flexibility in the ability to solve life's problems for changing environmental needs; 2. The concept of personality, that is, knowledge and knowledge about The internal organization of the individual and what the goals of the person are and what he is doing. 3. Ability to search and understand the correct and proper interpretation of the actual characteristics of the environment, especially those that are suitable for an organizational role (Milaniyafar, 2003). According to Kaplan and Saduko (1996), mental health is a welfare state that individuals are able to easily operate within their community, and personal development and personal qualities are satisfactory to them (Ganji, 2001). Healthy people have the power to face life needs. They usually feel responsible for their actions and deal with problems in the same way they happen. They have realistic ideas about what they can do. Therefore, they shape their environment as much as possible and adapt to it as necessary. They enjoy the fundamental experiences of life, but they never get enthralled. They explore experiences and exchange with the outside world. They spend most of their efforts on what they are doing, and they are happy to do so after that (Faghfuriyazar, 2007). Qadampour (1394) has shown in his research that significant organizational variables in the prediction of mental health of employees of governmental organizations, including organizational climate, working conditions, managerial style, and role ambiguity. Based on these results, there was no significant difference between the total mental health scale and its components in male and female employees. Today, the role of the manager as a leader has become so important that there is an ongoing effort in all areas to find people who have the ability to lead. The lack of leadership is not limited to private institutions, and in Government agencies are also tangible. Therefore, when the lack of leadership talent in society is mentioned, there is no lack of people who occupy administrative and administrative positions, but rather the lack of people who are ready to accept leadership roles in society and can do their job. (Iran NezhadParizi and SasanGohar, 2001). What is learned from human studies, management, and leadership is that success in leadership is related to the characteristics of the subconscious or the periphery, the environment, and the perception of the factors affecting them all; the characteristics of the leader must have become the actual characteristics that, in the genesis Leadership is effective. Managers and leaders have the same talents as all humans who have come to virtue through study and practice and skill; in such a situation, factors such as type of education, the cultural and social environment, and the administrative system are effective in the formation of leadership; then management And most of its traits are learnable; one who wants to be a manager can be fully confident in the management of science and technology; principally, the idea that management is inherent and does not require training is an inaccurate and harmful way. If the manager thinks that management is inherent, so he does not pay attention to the management training classes and makes himself and others unmanageable (Mirkamali, 2003). According to the above, the relationship between mental health and the style of leadership is trusted justifiably. Second hypothesis: There is a significant relationship between trustworthy leadership and optimism among employees of Amiralmomenin Burn Hospital in Shiraz. Data analysis has shown that there is a positive and significant relationship between trustworthy leadership and optimism at the level of 0.01. The findings of this study are consistent with the research findings of Rigo, Sasa, Marquise, Pinaw Cahn (2014). In the above explanation, it can be said that Rigo, Sosa, Marquaitis, Pinaco Cannes (2014) have shown that trustful leadership both directly and through two variables of hope and positive emotions of employees affects the creativity of employees. . It should be noted that two leadership tasks (tasks related to tasks or problem solving and preservation tasks of the group) should be represented (or implemented) in two different ways of leadership. Managers who are more concerned with solving problems consider the affairs and staff They make sure that things are satisfactorily done; doing things (in their view) is much more important than the growth of the members or the satisfaction of individuals. Managers who are more focused on the so-called corporate style (i.e. employees 'and employees' attention) tend to motivate them rather than control people. They try to be friendly and behavioral. Based on mutual respect with members and staff and allowing them to participate in decisions that affect their fate and work. Most managers have some of these leadership methods, but each manager is on one of the these two points of view emphasize more (Stoner, Frei I, the translation of the Parsahids and Arabs, 2000). By explaining, one can say that the theory of leadership alternatives, individual, organizational and organizational characteristics can be superior to the leader's ability to influence the satisfaction and performance of subordinates. In other words, if there are certain factors, one can perform the task without leading the leader. According to the foundations of the views of the leadership alternatives, and contrary to the traditional theories that always considered the hierarchy of leadership to be important, in many situations , The behavior of the leader is out of context and unnecessary. Features that can neutralize leadership behaviors include: ability, experience, knowledge, education, need for independence, professional orientation and indifference to organizational rewards. If a task can adequately meet the internal needs of the staff, they do not need to support the leader. The characteristics of organizations that may be able to replace leadership include: clear plans and objectives, the existence of rules and procedures, unified work groups, the existence of an exact structure of rewards and the existence of a physical distance between the supervisor and the subordinate (Cretan, 2007). Therefore, the leadership style is effective in making good friendship. Hypothesis 3: Trustful leadership and mental health predict a significant positive effect on employees of Amiralmomenin Burn Hospital in Shiraz. Data analysis has shown that trustful leadership style and mental health simultaneously account for 19% of goodness changes (p <0.01, F = 19.8) The findings of this study are consistent with the findings of Mullah Khalili and Ahmadi (1393), Poursardaro et al (1392), Tahmasian et al. (2011), Arakida (2006). In conclusion, it can be said that given a limited research in this regard, it can be concluded that, as we know, the goal of mental health of counseling and guidance and familiarizing people with the principles and proper relationships Human beings and to prevent them from threats that threaten mental health. This goal is achieved by creating an appropriate personal and social environment, and because mental health involves individuals both individually and collectively, the general principle for creating mental health, the health of the individual and social environment and for the achievement To this end, the following principles should be applied. The healthy person feels that the people of the community like him and he looks and agrees to them and respects them. An unusual person does not react in this way. He is usually pessimistic and admits that he never has a real friend in life and he does not trust anyone. In addition, he believes that the principles of mental health are based on the strengthening of individuals, rather than the destruction of their personality, according to these principles, should be tolerant and tolerant towards others, and in addition to punishment, encouragement and, in short, respect for the personality of the people. Applying these principles is of great use, and any person of any class with a class can help the community of people. To create mental health, many factors must be controlled. Mental health can be prevented by the prevention of mental illness, factors affecting the development of mental illness, the early diagnosis of mental illness, the prevention of complications resulting from the return of mental illness and the creation of a healthy environment for the establishment of proper human relationships. So, mental health is a science for the well-being of social welfare and logical reconciliation with the events of life, in mental health, what is more than anything else is respect for the personality and dignity of man. On the basis of this principle, mental health is a knowledge or art that helps individuals, by creating the right psychological and emotional methods, to adapt to their own environment and take appropriate solutions to solve problems (Ahmadvand, 1391). In the case of a trustful leadership style in predicting optimism, it should be said that in organizational groups or cooperative teams one of the most famous and growing dimensions of leadership theories and research in this field. Teams are grouped together by groups of members affiliated with and having shared goals. They must coordinate their activities to achieve goals. The new organizational structure in today's organizations, in fact, is power High-level decision-making in traditional organizations has shifted to more self-governing teams, giving them new powers in new areas. These new teams may still have a leader in its traditional sense or that the role of leader has been divided among team members. The formal role of the team leader may be restricted outside the group to serving as only an intermediary with outside or inside the group, mainly as a facilitator of the process, or both. Leadership within this new framework is still necessary but complex and offers a new field to the researchers. With the expansion of operational and organizational teams and development, its role in the structure of complex and changing rganizations is essential to understand the leadership role within these new teams to avoid being secured and defeated. The need for practical understanding of the nature of the organizational teams and leadership inside it guides the theory and research into a new direction that gives many promises to understand team leadership and team effectiveness. The leadership and effective leadership approach provides the most useful framework for understanding the current theories of operational teams and leadership. This approach is based on the practical view that is made around the productivity and product of the team that complicates team leadership with its critical interactions providing effectiveness. It is also a theoretical view of the fact that the emphasis on a large number of structural, individual and content processors, which relates to teamwork effectiveness, takes into account the complexity of teamwork, and most importantly, the attitude of leadership in Explains the design and supervision of teams to achieve effectiveness. The attitude of leadership and group effectiveness is a very useful tool for understanding many foundations and its emphasis on excellent quality products (Afjeh, 2006).Also, the optimism is a mood or attitude that, with expectation, is associated with a suitable and suitable social or non-social future that the appraiser evaluates socially according to his own request (Tiger, 1979 ). Positive beliefs are not optimistic in promising expressions or embodiments of success; they are rooted in the way people think about causes (Sylman, translation, DavarSpanah, 2004). Ultimately, mental health and a trustful leadership style have the ability to anticipate good visibility in people. From research constraints, we can use self-report tools (questionnaire), control of underlying factors and individual factors. It is also suggested that hospital officials use the results of this study. For research suggestions, it is suggested that larger samples be taken for comparative studies.

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