Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.5
,
No
.2
,
Jun
e
2
016
, pp
. 18
3
~ 1
92
I
S
SN
: 225
2-8
8
0
6
1
83
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Organizational Commitment
Can Improve Compliance of
Blood Transfusion Procedure
Edi Murw
ani,
Ste
f
anus
Sup
riyan
to,
Suh
arto
Facult
y
of Publi
c
Hea
lth
, Univ
er
sit
y
of Air
l
angg
a, Surabay
a
, Indo
nesia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Ja
n
5, 2016
Rev
i
sed
Mar
23
, 20
16
Accepted
May 20, 2016
The purpos
e of
this
res
ear
ch was
to
improve compliance of
nurses and
midwives on blood transfusion procedures thro
ugh increased or
ganization
a
l
com
m
itm
ent. The s
t
ud
y
us
ed obs
ervation
a
l a
n
al
yti
c
with cr
os
s
s
ectiona
l
approach
. Th
ere were 156 nurses and mi
dwives who meet the
in
clusion and
exclusion
criter
ia agr
eed
to
be p
a
rtic
ipated
as
r
e
spondents and 4
6
observers
agreed
involv
e
d
in th
e co
llection of
data thro
ugh informed consent.
The
sampling techn
i
que was simp
le random sampling. Data
instrument collectors
in the form of c
h
ecklists and questionnair
es. Analy
s
is of the data used in the
form
of des
c
ript
ive an
al
ys
is
, co
r
r
ela
tion,
and Str
u
ctural Equation
Modeling
(SEM). Based o
n
the f
i
ndings o
f
a n
e
w model,
a model
compliance nurses
and midwives on blood transfusion pr
ocedur
es, organization
a
l commitment
can improve compliance procedure of
bloo
d transfusion if affective
com
m
itm
ent and
norm
a
tive
com
m
itm
ent im
proved.
Keyword:
B
l
oo
d t
r
a
n
sf
usi
o
n
p
r
oced
ure
s
Co
m
p
lian
ce
Mid
w
iv
es
Nu
rses
Or
ga
ni
zat
i
onal
com
m
i
tm
ent
Copyright ©
201
6 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Ed
i Murwan
i,
Facu
lty of Public Health
,
Airlangga Uni
v
ersity,
Suraba
ya
East
Java
, I
n
do
nesi
a.
Em
a
il: ed
i
m
u
r
wan
i
@g
m
a
il.c
o
m
1.
INTRODUCTION
Or
ga
ni
zat
i
onal
com
m
i
tm
ent
i
s
(1
) a st
r
o
n
g
desi
re
t
o
rem
a
in as me
m
b
ers of
any pa
rticular
orga
nization; (2)
t
h
e desire
to stri
ve s
u
it the orga
nization;
and (3
) ce
rtain c
o
nfide
n
ce a
n
d accepta
nce
of t
h
e
val
u
es an
d goa
l
s
of
t
h
e or
ga
ni
zat
i
on [1]
.
C
o
m
p
li
ance
o
f
nu
rsi
n
g pers
o
nnel
i
n
bl
o
o
d
t
r
an
sf
usi
o
n pr
oce
d
u
r
e
wa
s
ru
di
m
e
nt
ary
.
It
was ca
used
ne
ar-m
i
ss and ad
verse e
v
e
n
t
s
i
n
bl
o
od t
r
ans
f
us
i
ons
wi
t
h
t
h
e i
m
pact
of
m
o
rb
i
d
i
t
y
an
d m
o
rtality [2
].
Death ca
use
d
by trans
f
usion
reactions
occur
1
(one
) pe
r 600.000 cases. Li
ke
an iceberg
phe
n
o
m
e
non,
near
-m
i
ss and adve
rse e
v
ent
s
hap
p
e
n
g
r
eat
e
r
. I
n
c
o
r
r
ect
B
l
oo
d C
o
m
pone
nt
Tra
n
sf
use
d
(IB
C
T
)
cau
sed
adv
e
r
s
e ev
en
ts.
Adv
e
rse ev
en
ts w
a
s r
e
p
o
r
t
ed
th
at
1
i
n
15
.00
0
tr
an
sfu
s
ion
s
[3
]-[4
] u
p
to
1
in
14
.0
00
tran
sfu
s
i
o
ns [5]; wh
ile th
e n
e
ar-m
iss o
ccu
rred
in
ab
ou
t 1
i
n
1.000
tr
an
sfusio
n
s
[
3
],
as
well as Linden e
t
al in
A
d
i
b
i et al (
201
2)
,
r
e
por
ted
t
h
at n
e
a
r-m
iss events
greate
r
incide
nce, c
o
mp
are
d
wi
t
h
dea
t
hs cause
d
by
r
eact
i
o
n
trans
f
usi
o
n, that occurred
1
/
60
0.000
cases, alth
o
ugh
th
e n
e
ar
-
m
iss ev
en
ts w
e
r
e
no
t kn
own
ho
w
th
e fr
equ
e
n
c
y
[4]
.
Th
us,
com
p
l
i
a
nce of
n
u
r
s
i
ng pe
rso
n
n
el
i
n
bl
o
o
d
t
r
a
n
sf
u
s
i
on p
r
oce
d
ure
com
p
l
e
t
e
l
y
(100
%) was nece
ssary
to
su
ppo
rt
p
a
tien
t
safety.
The
pr
obl
em
is l
o
w c
o
m
p
l
i
a
nce o
f
nu
rsi
n
g
pers
o
nnel
i
n
t
h
e bl
oo
d t
r
a
n
sfusi
o
n
p
r
oce
d
ure at
t
h
e
hos
pi
t
a
l
has an
avera
g
e val
u
e
of 8
1
.
0
2% o
r
i
n
t
h
e m
e
di
u
m
cat
egory
,
has
not
bee
n
10
0%
or r
udi
m
e
nt
ary
[6]
.
In
an
ef
fo
rt
t
o
i
n
crease c
o
m
p
l
i
a
nce o
f
n
u
rsi
n
g
pers
o
nnel
i
n
bl
o
o
d
t
r
a
n
sf
usi
o
n
p
r
oced
ure
s
fo
u
n
d
a
new
m
odel
,
a
m
odel
com
p
li
ance of n
u
r
s
i
n
g per
s
o
n
n
el
i
n
bl
oo
d t
r
ans
f
us
i
on p
r
oce
d
ures
. B
a
sed on t
h
e
m
odel
,
i
t
reveal
ed
th
at on
e
o
f
th
e f
actor
s t
h
at inf
l
u
e
n
ces to com
p
l
i
an
ce of
nu
r
s
i
n
g p
e
r
s
o
nnel in
b
l
oo
d tr
an
sfu
s
ion pr
o
c
ed
ur
e is
or
ga
ni
zat
i
onal
com
m
i
tm
ent
[7]
.
The p
r
o
b
l
e
m
of or
gani
zat
i
onal
com
m
i
tm
ent
has ne
gat
i
v
e effect
si
gni
fi
cant
l
y
on c
o
m
p
l
i
a
nce of n
u
r
si
n
g
pers
o
nnel
i
n
t
h
e bl
o
o
d
t
r
an
sfusi
on
pr
oce
d
u
r
e [
7
]
.
It
m
eans t
h
at
t
h
e hi
gh
e
r
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
18
3 – 1
9
2
18
4
or
ga
ni
zat
i
onal
com
m
itm
ent dec
r
easi
n
g c
o
m
p
l
i
a
nce of
n
u
rse
s
a
n
d
m
i
dwi
v
es i
n
t
h
e bl
oo
d
t
r
a
n
sf
usi
o
n
pr
oce
d
u
r
es.
S
o
t
h
at
t
h
e
f
o
r
m
ul
at
i
on o
f
t
h
e p
r
obl
em
of
t
h
i
s
resea
r
ch
i
s
as f
o
l
l
o
ws
. C
a
n
or
ga
ni
zat
i
onal
com
m
i
tm
ent
im
prove c
o
m
p
li
ance o
f
nu
rse
s
an
d m
i
dwi
v
e
s
’ bl
oo
d t
r
a
n
s
f
usi
o
n
pr
oce
d
u
r
e t
o
su
p
p
o
r
t
p
a
t
i
e
nt
safety
?
2.
R
E
SEARC
H M
ETHOD
Th
e
d
e
sign
o
f
th
is stud
y was an
a
n
alytic correlation
with cro
ss sect
i
onal
a
p
pr
oach
.
The st
udy
p
opu
latio
n
s
were nu
rses and
m
i
d
w
iv
es in
th
e In
p
a
tien
t
I
(Med
icin
e and
Strok
e
Un
it), In
p
a
tien
t
II (M
ed
icin
e
Su
rg
ery),
Inp
a
t
i
en
t III (Obstetrics & Gy
n
ecolo
g
y
) and
An
esth
esi & Rean
i
m
atio
n
In
stallatio
n
,
in
on
e
o
f
typ
e
A Ed
ucatio
n
Ho
sp
ital in
Ind
o
n
e
sia i
n
April to
Ju
ly 201
3. Th
e
po
pu
l
a
tio
n
s
were 41
0 p
e
op
le [8
]. Targ
et
po
p
u
l
a
t
i
ons
we
re 36
4 pe
opl
e,
and
n
o
t
t
a
r
g
et
po
p
u
l
a
t
i
ons
we
re 46
pe
o
p
l
e
.
Sam
p
les o
f
t
h
is
d
i
ssertation
were nu
rses and
m
i
d
w
ives who
m
e
t
th
e in
cl
u
s
ion
criteria: (1)
im
pl
em
ent
i
ng nu
rsi
n
g/
m
i
dwi
f
ery
;
(
2
) ca
rry
out
a
bl
o
od t
r
a
n
sf
usi
o
n i
n
ad
ul
t
pat
i
e
nt
s.
(
3
) t
h
e i
m
pl
ement
a
t
i
o
n
of t
h
e o
b
se
rvat
i
ons:
(a
)
begi
n
n
i
n
g o
f
t
h
e
p
r
o
g
ram
a doct
o
r,
(b
) bl
oo
d sam
p
l
i
n
g
,
(c
) se
ndi
ng
bl
o
o
d
sam
p
l
e
s t
o
the Blood Bank/UT
D
or othe
rs hospita
l, (d) acceptance of the blood
of B
l
ood Bank/UT
D
or
othe
rs hospital,
(e)
pre
p
arat
i
o
n
t
o
ent
e
r i
n
t
o
t
h
e pat
i
e
nt
'
s
bl
ood
, (
f) t
h
e i
m
plem
ent
a
t
i
on o
f
bl
o
od e
n
t
e
ri
ng
i
n
t
o
t
h
e
pat
i
e
nt
unt
i
l
t
h
e fi
rst
p
u
m
pki
n fi
ni
she
d
;
(
4
)
one
res
p
o
n
d
ent
obs
er
ved
one t
i
m
e. Excl
usi
o
n cri
t
e
ri
a
:
(1) t
h
e hea
d
of t
h
e
in
f
i
r
m
ar
y, th
e d
e
p
u
t
y h
e
ad
o
f
t
h
e tr
eatm
e
n
t
ro
o
m
an
d
h
ead ro
o
m
in
case of
h
o
s
pitalizat
io
n
;
(2
) b
l
ood
t
r
ans
f
usi
on
p
u
m
pki
n i
n
t
o
t
w
o an
d s
o
on
.
A l
a
r
g
e sam
p
le of
1
56
pe
op
l
e
, sam
p
l
i
ng t
echni
que
s was
sim
p
l
e
r
a
n
d
o
m s
a
mp
l
i
n
g
.
Inst
rum
e
nt
s da
t
a
were q
u
est
i
on
nai
r
e a
nd c
h
eckl
i
s
t
.
Based
on
th
e th
eory th
at su
pp
orts stru
ctured
g
r
ating
in
st
rumen
t
s th
en
con
s
u
lted
to
ex
perts (p
ro
m
o
ters and
co-pro
mo
ter) t
o
fu
lfill co
n
t
en
t v
a
lid
i
t
y an
d
co
nstru
c
t
v
a
lidity. Fu
rt
h
e
rm
o
r
e, th
e qu
estionn
aire
of
o
r
g
a
n
i
zatio
n
a
l co
mmit
m
e
n
t
m
a
d
e
ed
its to
t
h
e
In
don
esian
Dep
a
rtm
e
n
t
o
f
th
e Facu
lty of Letters, State Un
iv
ersity
of
M
a
l
a
ng t
o
c
o
nf
orm
t
o
t
h
e
r
u
l
e
s o
f
gram
m
a
r an
d
easily underst
o
od
by the la
ym
an. Statistical validity
test use
d
S
PSS
11.
5
,
with
Pearson
P
r
oduct Mom
e
nt
co
rrelatio
n
tech
n
i
q
u
e
, th
e
ite
m
-
to
tal co
rrelatio
n
b
y
measuri
n
g
the correlation sc
ore of
eac
h of
t
h
e
que
st
i
ons/
s
t
a
t
e
m
e
nt
s wi
t
h
a score
of q
u
est
i
o
ns/
s
t
a
t
e
m
e
nt
s as a wh
ol
e. The
si
gni
fi
can
ce l
e
vel
of
0.
00
1
wi
t
h
a
mark
** and t
h
e significance
lev
e
l
of 0
.
05
with
a *
[9
].
Reliab
ilit
y test
were statistically an
alyzed
b
y
Cronb
ach
Alph
a [1
0
]
. Th
e qu
estionn
aire said
to
b
e
reliab
l
e, if th
e v
a
lu
e of Cronbach Alpha
≥
0
,
6
0
[9
]. To
d
e
term
in
e th
e feasib
ility o
f
th
e research
instrumen
t
s
t
h
at
can
be a
n
al
y
zed fu
rt
he
r
co
nd
uct
e
d e
x
pl
o
r
at
ory
fact
o
r
anal
y
s
i
s
.
Ac
cor
d
i
n
g t
o
Sa
nt
os
o Si
ng
gi
h
(2
0
0
4
)
stan
d
a
rd
used is
th
e v
a
lu
e o
f
th
e
Kaiser-Meyer-Ol
k
in Me
asure
of
Sa
m
p
l
i
ng
Ade
q
uacy
(KM
O
)
>
0.
5
wi
t
h
a
si
gni
fi
ca
nce fa
r bel
o
w 0.
05
(
0
.0
00
< 0.
05
) [1
1]
.
Or
ga
ni
zat
i
onal
com
m
i
tm
ent
q
u
est
i
o
nnai
r
e
p
r
epare
d
by
m
odi
fi
cat
i
on o
f
t
h
e
co
ncept
of
o
r
g
a
ni
zat
i
onal
com
m
i
tm
ent
M
e
y
e
r & Al
l
e
n [
12]
.
Ho
spi
t
al
nur
si
n
g
st
af
f ex
pres
s o
f
c
once
r
n f
o
r
ho
s
p
i
t
a
l
s
and s
u
cc
ess an
d
sust
ai
na
bl
e pr
o
g
ress
. O
r
ga
ni
z
a
t
i
onal
com
m
i
tm
ent
m
easur
ed from
: (1) affective co
mmit
m
en
t, (2
)
n
o
rmativ
e
commitment and (3) co
n
tinu
a
n
c
e co
mm
it
men
t
. Qu
estion
n
a
i
r
es affecti
v
e co
mmit
m
e
n
t is an
em
o
tio
n
a
l
attach
m
e
n
t
to
an
assessm
en
t o
f
th
e
n
u
rsing
staff in
ho
sp
itals, id
en
tification
,
and
invo
lv
emen
t in
th
e activ
ities
o
f
th
e
h
o
sp
ital. Qu
estio
nn
aires n
o
rm
ativ
e c
o
mmit
m
en
t is
an
em
o
tio
n
a
l attach
m
e
n
t
to
an
assessm
en
t o
f
th
e
n
u
rsing
staff at th
e h
o
s
p
ital by feelin
g
ob
liged
to
k
e
ep
work
ing
at th
e h
o
sp
ital h
a
d
to
b
e
so
; and
su
ch
actio
n
is
th
e righ
t th
in
g. Qu
estionn
aires o
f
co
ntinua
nce commitment is an e
m
otiona
l attachm
e
nt to an assessment of
t
h
e h
o
spi
t
a
l
n
u
rsi
ng st
a
ff
ba
sed o
n
c
onsi
d
erat
i
ons l
o
ss i
f
out
o
f
t
h
e
ho
spi
t
a
l
,
suc
h
as
l
o
ss o
f
seni
or
i
t
y
on
pr
om
ot
i
on or
bene
fi
t
.
M
easu
r
em
ent
by
perfo
rm
i
ng t
h
e abo
v
e
-
m
e
nt
i
oned q
u
est
i
o
nnai
r
e t
h
at
uses sem
a
nt
i
c
scal
e defere
nsi
a
l
10 p
o
i
n
t
s
t
o
assess t
h
e st
at
em
ent
s
rangi
ng
fr
om
st
rongl
y
di
sagree
p
o
i
n
t
s
1 s
d
1
0
poi
nt
s
stro
ngly
a
g
ree
[1
3]
.
C
h
eckl
i
s
t
com
p
l
i
a
nce n
u
r
s
i
n
g st
aff
on t
h
e
pr
oced
u
r
e of
bl
oo
d t
r
a
n
sf
u
s
i
on c
onsi
s
t
s
of c
h
eckl
i
s
t
proce
d
ures: (1) blood sam
p
ling, (2)
bl
ood sa
m
p
les delivery to the Blood Ba
nk Hos
p
ital, (3) acce
ptance
of the
b
l
oo
d fr
o
m
Blo
o
d
Bank
H
o
sp
ital, (4
) pr
ep
ar
atio
n to
i
n
se
rt
t
h
e bl
oo
d
t
o
t
h
e pat
i
e
nt
s,
(
5
)
t
h
e i
m
pl
em
ent
a
t
i
on
of
th
e in
sert
b
l
ood
to
th
e
p
a
tien
t
s. Co
m
p
lian
ce measu
r
ed
b
y
di
rect
o
b
ser
v
at
i
o
n. E
v
al
uat
i
o
n
o
f
q
u
est
i
o
nnai
r
e
s
and
ch
eck
lists u
s
ing
rates wh
ich
co
m
p
are
th
e
acq
u
i
sition
of sco
r
es co
m
p
ared
wit
h
th
e t
o
tal sco
r
e
[1
4
]
,
with
the
expecte
d
outcomes in the form of a perce
n
tage (%
). T
h
en
categorized int
o
a perfect
(
100
%), h
i
gh
(
>
90
% -
<
10
0%
), m
ode
r
a
t
e
(8
0-
9
0
%)
, l
o
w
(<
8
0
%)
,
b
a
sed
o
n
m
odi
fi
cat
i
ons t
o
t
h
e
c
o
m
p
l
i
a
nce of
fi
nanci
a
l
m
a
nag
e
m
e
nt
[1
5]
.
In t
h
e fi
rst
st
a
g
e obs
er
ver
wh
o ha
d si
g
n
e
d
i
n
f
o
rm
ed co
nse
n
t
,
i
n
e
v
ery
r
o
om
obser
vi
n
g
t
h
e p
r
ocess o
f
bl
o
od t
r
a
n
s
f
us
i
on t
o
t
h
e res
p
o
n
d
ent
s
(
w
h
o
ha
d ch
osen
rand
om
l
y
). The t
i
m
i
ng of
obs
er
vat
i
on
w
a
s al
so
det
e
rm
i
n
ed ra
n
dom
l
y
by
t
h
e prese
n
ce
of
o
b
s
erve
rs, t
h
e re
spo
n
d
e
n
t
,
an
d
t
h
e pat
i
e
nt
s
w
ho
u
nde
r
w
ent
bl
o
o
d
t
r
ans
f
usi
o
n
s
. T
h
e ne
xt
st
age
aft
e
r
al
l
resp
o
nde
nt
s
c
o
m
p
l
e
t
e
d obse
r
ved
,
aft
e
r res
p
o
n
d
e
n
t
s
si
g
n
e
d
i
n
f
o
rm
ed
co
nsen
t,
th
e resp
ond
en
ts
filled
o
u
t
qu
estionn
aires.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Org
a
n
i
z
at
i
o
n
a
l
C
o
m
m
i
t
m
e
n
t
C
a
n
I
m
pr
ove
C
o
m
p
l
i
a
nce of
Bl
oo
d Tra
n
sf
us
i
on Proce
d
ure (
E
di
Murw
a
n
i
)
18
5
The dat
a
we
re
anal
y
zed usi
n
g desc
ri
pt
i
v
e
,
Pears
on P
r
od
u
c
t
M
o
m
e
nt
, and SEM
.
De
scr
i
pt
i
v
e wa
s
use
d
t
o
anal
y
s
e descri
pt
i
o
n o
f
or
ga
ni
zat
i
ona
l
co
m
m
i
tm
ent
and c
o
m
p
l
i
a
nce of n
u
rses a
n
d m
i
dwi
v
es i
n
bl
o
o
d
t
r
ans
f
usi
on
pr
o
cedu
r
e. Pea
r
s
o
n Pr
o
duct
M
o
m
e
nt
C
o
rrel
a
t
i
on a
n
al
y
s
ed t
h
e rel
a
t
i
ons
hi
p
bet
w
ee
n o
r
ga
ni
zat
i
onal
commitment indicator a
n
d c
o
m
p
liance indi
cator. SEM
wi
th
Li
srel
8.
3
0
pr
o
g
ram
an
alysed t
h
e relationshi
p
bet
w
ee
n va
ri
a
b
l
e
s i
n
o
r
der t
o
fi
n
d
a m
ode
l
com
p
l
i
a
nce
of
nu
rses a
n
d m
i
dwi
v
es i
n
t
h
e bl
oo
d t
r
a
n
s
f
usi
o
n
pr
oce
d
u
r
e.
2.
1.
Rese
arch E
t
hi
cs
This study ha
d been com
p
lied researc
h
ethi
cs, base
d on (a
) Certificate of escaped exam
ine ethics of
Health Resea
r
c
h
Ethics
Committee of t
h
e Faculty of
Pu
b
lic Health
, Airlan
gg
a
Un
iv
ersity. Th
e
d
a
ted Feb
r
u
a
ry
5, 2
0
13
wi
t
h
num
ber:
2
0
K
E
PK;
(
b
) T
h
e
n
ha
d bee
n
pe
rm
it
t
e
d t
h
e st
udy
of t
h
e
Di
re
ct
or d
r
. Sai
f
ul
An
war
M
a
l
a
ng H
o
s
p
i
t
a
l
wi
t
h
num
bers:
07
0/
2
5
29/
3
02/
20
1
3
dat
e
d
M
a
rch 2
2
,
20
1
3
;
(c) ap
p
r
o
v
e
d
o
f
t
h
e 4
6
o
b
s
e
rve
r
s
th
ro
ugh
inf
o
r
m
ed
co
nsen
t, and
(
d
)
ap
pro
v
e
d
o
f
156
r
e
spon
den
t
s thr
oug
h the in
fo
r
m
ed
consen
t.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
3.
1.
Organiz
a
tional Commi
tme
n
t
Nurses
and Midwives
Org
a
n
i
zatio
n
a
l
co
mmi
t
m
en
t
was a laten
t
v
a
riab
le th
at
m
e
a
s
u
r
ed
b
y
th
e lev
e
l o
f
subv
ariab
l
e affectiv
e
commitment, norm
ative commitm
ent,
cont
i
nua
nce c
o
m
m
i
tm
ent
nu
rse
s
an
d m
i
dwi
v
es. It
was
pres
ent
e
d i
n
Tabl
e 1.
Tabl
e
1.
Or
ga
n
i
zat
i
onal
C
o
m
m
i
tm
ent
of
N
u
rses a
n
d M
i
d
w
i
v
es i
n
H
o
s
p
i
t
a
l
(n
=
15
6)
Indicator & Sub
I
ndicato
r Average
Value
Cat
e
gory
Affec
t
iv
e Co
mmi
t
men
t
The desire to sta
y
i
n
the hospital because of
the love
86.00%
Mediu
m
T
h
e significance hospital
87.
00%
M
e
diu
m
AverageValue
87.
00%
M
e
diu
m
Nor
m
ative Co
m
m
i
t
m
ent
Heavy
feeling to leaving the hospital
84.
00%
M
e
diu
m
Keep working in hospitals as a place
to learn and get a j
ob f
i
rst
86.00%
Mediu
m
Co
m
p
l
y
ing with ru
les and regulations
were
a
m
o
ral
resp
onsibility
90.00%
High
Average Value
86.
50%
M
e
diu
m
Continuance Comm
i
t
m
e
nt
The idea that it
wo
uld be better if som
e
one wa
s still
w
o
rking in the organ
i
zation througho
ut
his/her caree
r
74.
00%
L
o
w
The desire to keep
working at the
hospital to par
ticipate
in developin
g
a career
and hospitals
86.
00%
M
e
diu
m
Average Value
80.
00%
M
e
diu
m
The average value of
organiz
a
t
ional co
m
m
i
tm
ent
of
nurses and
m
i
dw
ives
84.
50%
M
e
diu
m
B
a
sed o
n
t
a
bl
e 1, i
t
can be concl
ude
d t
h
at
t
h
e or
ga
ni
zat
i
o
nal
com
m
i
tm
ent
of n
u
r
ses an
d m
i
dwi
v
es
was
n
o
t
p
e
rfect (10
0
.00
%
), st
ill in
th
e m
e
d
i
u
m
categ
o
r
y (84
.
5
0
%).
Th
is
was
d
u
e
t
o
a mean
v
a
lu
e
o
f
affectiv
e
co
mmit
m
en
t su
ppo
rted
in
the
m
e
d
i
u
m
ca
tegory (87.00%
)
, norm
ative co
mmitm
ent in the m
e
diu
m
category
(86.50%), and the continua
nce commitm
ent
i
n
t
h
e
m
e
di
um
cat
egory
(8
0.
00
%).
In
det
a
i
l
were prese
n
t
e
d i
n
Fi
gu
re 1.
84.
0
74.00%
8
7
86
86
8
6
80.00
%
Norm
ative Com
m
i
tment
C
ontinuance C
o
m
m
itm
e
nt
Organizational com
m
i
tm
ent
Target
Average Value
Indicator
3
Indicator
2
Indicator
1
Figure 1.
Average Value of Orga
ni
zat
i
onal
C
o
m
m
i
tm
ent
of
Nu
rses a
n
d M
i
dwi
v
es at t
h
e
Hos
p
ital (n =
156)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
18
3 – 1
9
2
18
6
3.
2.
Com
p
liance
of Nurses
an
d
Midwives
on
the Blood Tr
ansfusi
o
n
Proc
edure
C
o
m
p
l
i
a
nce of n
u
rse
s
an
d
m
i
dwi
v
es o
n
t
h
e bl
o
o
d
t
r
a
n
sf
usi
o
n
pr
oc
edu
r
e m
easure
d
f
r
om
t
h
e
com
p
l
i
a
nce of
(1
)
bl
o
od
sa
m
p
li
ng
pr
oced
ure
,
(
2
)
bl
oo
d
sam
p
l
e
s del
i
v
ery
t
o
t
h
e B
l
oo
d B
a
n
k
Ho
spi
t
al
, (3
)
bl
o
od a
d
m
i
ssi
on f
r
om
B
l
ood
B
a
nk
H
o
spi
t
a
l
,
(4
) bl
oo
d i
n
se
rt
pre
p
a
r
at
i
o
n
,
(5
) bl
oo
d i
n
ser
t
im
pl
em
ent
a
tion
.
It
was
not
per
f
ec
t
or i
n
t
h
e m
e
di
um
cat
egory
(
7
8
.
7
2
%
)
.
It
wa
s co
nt
ri
b
u
t
t
e
d
f
r
om
t
h
e val
u
e
of t
h
e c
o
m
p
l
i
a
nce
of
sam
p
l
i
ng pro
cedu
r
e i
n
t
h
e l
o
w cat
eg
ory
(7
6.
1
9
%)
, co
m
p
li
ance of bl
o
od a
d
m
i
ssion f
r
o
m
B
l
ood B
a
n
k
Ho
sp
ital in
th
e lo
w catego
ry (7
9.82
%), co
mp
lian
ce
o
f
b
l
ood
in
sert im
p
l
e
m
en
tatio
n
in
to
th
e p
a
tien
t
i
n
t
h
e l
o
w
categ
or
y (72
.
16
%), althou
gh co
m
p
lian
ce of
b
l
oo
d sam
p
le
d
e
liv
ery to
Blo
o
d
Ban
k
Ho
sp
ital in th
e
med
i
u
m
category (85.08%) and c
o
m
p
liance bl
ood i
n
sert pre
p
ar
at
i
o
n i
n
t
h
e
m
e
di
um
cat
e
gory
(
8
0.
30
%).
T
h
e a
v
era
g
e
values
we
re presented
in Figure 2.
76.29%
85.08%
79.82%
80.30%
72.16%
78.72%
100.00%
C
.
B
l
ood Sam
p
ling
Procedure
C
.
B
l
ood Sam
p
le
Delivery
Procedure
C
.
B
l
ood Adm
i
ssion
Procedure
C
.
B
l
ood Insert
Preparation
Procedure
C
.
B
l
ood Insert
Im
plem
entation
Procedure
C
.
B
l
ood Transfusion Procedure
Target
F
i
g
u
r
e
2
.
T
h
e
A
v
er
ag
e
V
a
lu
e of
Co
mp
lia
n
c
e
of
N
u
r
s
e
s
and
Midw
iv
e
s
in
th
e
Bloo
d T
r
ans
f
u
s
io
n Pr
o
c
edu
r
e
(n
=
15
6)
3.
3.
Infl
uence of org
a
ni
z
a
ti
on
a
l
co
mmitment indicator
s
with indica
tors of c
o
mpli
ance nurses
and
midwives in
the blood tr
ans
f
usion pr
ocedure
Tabl
e 2 sh
o
w
ed eac
h o
r
gani
zat
i
o
nal
com
m
i
tm
ent
and c
o
m
p
l
i
a
nce i
ndi
cat
or
h
a
s si
gni
fi
ca
nt
i
n
fl
ue
nces ei
t
h
er
. I
ndi
cat
or
of
or
ga
ni
zat
i
onal
c
o
m
m
i
tment that affected com
p
lian
c
e in
d
i
cator was on
ly
cont
i
n
ua
nce c
o
m
m
itm
ent
.
It
had
ne
gat
i
v
e
ef
fect
si
g
n
i
f
i
cant
l
y
on t
h
e
bl
o
o
d
i
n
sert
p
r
epa
r
at
i
on
p
r
oce
d
ure.
Tabl
e
2.
In
fl
ue
nce
of
O
r
ga
ni
zat
i
onal
C
o
m
m
i
tm
ent
In
di
cat
or
t
o
C
o
m
p
l
i
a
nce
of
N
u
r
s
es an
d M
i
dwi
v
es i
n
t
h
e
Blo
o
d
Tr
an
sfusio
n Pro
c
ed
ur
e In
d
i
cator
(
n
=
1
56)
Influence
Correlation
Coefi
s
ien
Conclusion
Af
f
ective co
mm
it
m
e
nt
Nor
m
a
tive co
mm
it
m
e
nt
0.796**
Signif
i
cant
Af
f
ectiv
e co
mm
it
m
e
n
t
Continuance co
m
m
it
m
e
nt
0.
616*
*
Significant
Norm
ative
co
m
m
itm
ent
Continuance co
m
m
it
m
e
nt
0.
689*
*
Significant
Affective co
m
m
itm
e
nt
Com
p
liance of blood
sam
p
ling
-
0
.
101
Not significant
Affective co
m
m
itm
e
nt
Com
p
liance of blood
sam
p
les deliver
y
-
0
.
108
Not
significant
Affective co
m
m
it
m
e
nt
Com
p
li
ance of blood
acceptance
0.026
Not significant
Affective co
m
m
itm
e
nt
Com
p
li
ance of blood
inser
t
pr
epar
ation
-
0
.
052
Not significant
Affectiveco
m
m
itm
e
nt
Co
m
p
lia
nce of blood ins
e
r
t
i
m
plem
entation
0.
008
Not significant
Norm
ative
co
m
m
itm
ent
Co
m
p
liance of bloo
d sam
p
ling
-
0
.
140
Not significant
No
r
m
ativ
e
co
mm
i
t
m
e
n
t
Co
mp
lian
ce
of bloo
d sam
p
les delivery
-
0
.
099
Not significant
Nor
m
ative
co
mm
i
t
m
e
n
t
Co
mplian
ce of
blood acceptance proce
dure -0.014
Not
signif
i
cant
Norm
ative
co
m
m
itm
ent
Co
m
p
liance of bloo
d in
ser
t
pr
epar
ation
-
0
.
094
Not significant
Norm
ative
co
m
m
itm
ent
Co
m
p
liance of bloo
d in
ser
t
i
m
ple
m
entatio
n
-
0
.
031
Not significant
Continuance co
m
m
itm
ent
Co
m
p
liance of blood sam
p
ling
-
0
.
150
Not significant
Co
n
tin
u
a
n
ce co
m
m
i
t
m
en
t
Co
m
p
liance of blo
od sam
p
les
delivery
-
0
.
126
Not significant
Continuance co
m
m
i
t
m
ent
Co
m
p
liance
of blood acceptance
-0.070
Not significant
Continuance co
m
m
itm
ent
Co
m
p
liance of blo
od inser
t
pr
epar
ation
-
0
.
160*
Significant
Co
n
tin
u
a
n
ce co
m
m
i
t
m
en
t
Co
m
p
lian
c
e of blo
od inser
t
im
ple
m
enta
tion
-
0
.
141
Not significant
Co
m
p
liance Pr
ocedur
e of
Blood sam
p
ling
Blood sam
p
le deliver
y
0.
631*
*
Significant
Blood sam
p
ling
Blood acceptance
0.
545*
*
Significant
Blood sam
p
ling
Blood inser
t
pr
epar
ation
0.
777*
*
Significant
Blood sam
p
ling
Blood inser
t
i
m
ple
m
entatio
n
0.
715*
*
Significant
Blood sa
m
p
les deli
very
Blood acceptance
0.543*
*
Significant
Blood sam
p
les deliver
y
Blood inse
r
t
pr
epar
ation
0.
651*
*
Significant
Blood sam
p
les deliver
y
Blood inser
t
im
ple
m
entation
0.
538*
*
Significant
Blood acceptance
Blood insert preparation
0.548*
*
Significant
Blood acceptance
Blood insert i
m
pl
e
m
entation
0.538*
*
Significant
Blood inser
t
pr
epar
ation
Blood inser
t
im
ple
m
entation
0.
695*
*
Significant
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
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:
225
2-8
8
0
6
Org
a
n
i
z
at
i
o
n
a
l
C
o
m
m
i
t
m
e
n
t
C
a
n
I
m
pr
ove
C
o
m
p
l
i
a
nce of
Bl
oo
d Tra
n
sf
us
i
on Proce
d
ure (
E
di
Murw
a
n
i
)
18
7
Tabl
e 2
c
o
ncl
ude
d
t
h
at
(1
) t
h
e
af
fective c
o
mmitment
and norm
ative
co
m
m
i
tm
ent
di
d
not
di
rect
l
y
aff
ect
com
p
liance of
(a)
blood sam
p
le taking, (b) s
e
ndi
ng of
bl
ood sam
p
les, (c)
blood
accepta
nce, (d)
blood insert
pre
p
arat
i
o
n,
a
nd
(e
) bl
oo
d i
n
sert
i
m
pl
em
ent
a
t
i
on.
(
2
) c
o
m
p
li
ance of
n
u
rses
an
d m
i
dwi
v
es i
n
bl
o
o
d
i
n
se
rt
pre
p
arat
i
o
n
wa
s not
onl
y
i
n
fl
uence
d
by
t
h
e
com
m
i
tm
ent
cont
i
n
ua
nce,
bu
t
i
t
was i
n
fl
ue
n
ced by
c
o
m
p
l
i
ance o
f
nu
rses a
nd m
i
dwi
v
es i
n
t
h
e
pr
oce
d
u
r
e o
f
b
l
oo
d sam
p
l
i
ng,
bl
oo
d sam
p
l
e
del
i
v
ery
i
n
t
o
B
l
oo
d B
a
nk
H
o
spi
t
a
l
,
an
d
b
l
oo
d accep
tan
c
e fro
m
th
e Bl
o
o
d
B
a
n
k
Ho
sp
ital
also
.
It
h
a
d t
h
e si
g
n
i
fican
t
po
sitiv
e effect. (3
)
co
m
p
lian
ce o
f
b
l
o
o
d
in
ser
t
p
r
ep
ar
ation
influ
e
n
c
ed
co
m
p
lian
ce o
f
b
l
ood
in
ser
t
im
p
l
e
m
en
tatio
n
;
alt
h
ough
com
p
l
i
a
nce of
bl
o
o
d
i
n
se
rt
i
m
pl
em
ent
a
t
i
on was i
n
fl
ue
nce
d
by
c
o
m
p
l
i
a
nce of
(a
)
bl
o
o
d
sam
p
l
i
ng, (
b
)
s
e
ndi
ng
blood sam
p
les to the Blood Bank
Ho
spital and
blood acce
ptance from
Blood
Ba
nk
Hos
p
i
t
al. It was pres
ented
in
Figur
e
3
.
Fi
gu
re
3.
I
n
fl
u
e
nce
of
O
r
ga
ni
zat
i
onal
C
o
m
m
i
tm
ent
Indi
cat
o
r
t
o
C
o
m
p
l
i
a
nce o
f
Nu
rses a
n
d M
i
d
w
i
v
es
o
n
t
h
e
B
l
oo
d T
r
ans
f
u
s
i
o
n
Pr
oce
d
u
r
e
I
ndi
cat
o
r
(n=
1
56
)
3.
4.
T
h
e resul
ts
o
f
the
an
al
ysi
s
o
f
Stru
ctur
al
E
qua
ti
on
Mod
e
l
i
n
g (
S
E
M
)
3.
4.
1.
Co
nfi
r
m
a
t
o
r
y
Fac
t
or
A
n
al
y
s
i
s
(C
FA
)
of
O
r
ga
ni
z
a
ti
on
al
Com
m
i
t
men
t
of
Nur
s
es
and
Mi
dw
i
v
es
Or
ga
ni
zat
i
onal
com
m
itm
ent
(C
om
org
)
was
a t
w
o l
e
vel
of l
a
t
e
nt
vari
abl
e
. It
was
m
e
asure
d
f
r
om
affective c
o
mmitment (Affct
iv
e) wh
ich
h
a
d
2
ind
i
cators, no
rm
ativ
e
co
mmit
m
en
t (Nrm
ativ
e) wh
ich had
three
i
ndi
cat
o
r
s, a
n
d c
ont
i
n
ua
nce
com
m
i
tm
ent
(C
nt
i
n
ua
nc)
whi
c
h
had
t
w
o i
n
di
cat
o
r
s.
I
ndi
cat
o
r
of
af
fect
i
v
e
commitment
was (1) t
h
e desire to st
ay in the hos
p
ital because
of t
h
e love (L
OVE
)
, (2) t
h
e significance
hos
pital (MEAN).
Indicator of norm
ative com
m
itm
ent was
(1)
heavy feel
ing to leaving
the hospital (F
EEL),
(2)
k
eep wo
rk
i
n
g in
ho
sp
itals
as a p
l
ace to
learn
and
g
e
t a
jo
b first
(FRS
TJOB), (3
) co
m
p
lyin
g
with
ru
les and
regu
latio
n
s
are
m
o
ral respo
n
s
ib
ility
(MORAL). In
d
i
cat
o
r
of co
n
t
i
n
u
a
n
ce
co
mmit
m
en
t was (1
) th
e id
ea th
at it
w
o
u
l
d b
e
b
e
tter if so
m
e
o
n
e
is still w
o
rk
ing
in th
e
org
a
n
i
zatio
n
thro
ugho
u
t
h
i
s
career (ON
E
O
R
G), (2
)
t
h
e
d
e
sire t
o
k
eep
work
i
n
g
in
ho
sp
ital to
p
a
rticip
ate in
d
e
v
e
lop
i
ng
a career an
d ho
sp
itals (C
AREER). Resu
lts of
co
nfirm
a
to
ry facto
r
an
alysis
were presen
ted in
Fi
g
u
re
4
.
+0.796**
Normative
Commitment
Affec
t
iv
e
C
o
m
m
i
tm
e
n
t
C.Blood
Sampling
C.Blood Insert
Pre
p
arat
ion
Continuance
C
o
m
m
i
tm
e
n
t
C.
Blood Insert
Im
p
le
m
e
ntation
C.Blood Sample
Delive
r
y
C.Blood
Accep
tan
c
e
+0.538**
+0.715**
+0.538**
+0.695**
+0.616**
+0.545**
+0.548**
+0.651**
+0.689**
-0.160*
+0.631**
+0,777**
+0.543**
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
18
3 – 1
9
2
18
8
Co
m
m
o
r
g
1.
0
0
A
f
fc
ti
v
e
\
Nr
m
a
ti
v
e
C
n
t
i
nua
n
ME
A
N
0.
5
0
LO
V
E
0.
18
FE
E
L
0.
31
FR
S
T
J
O
B
0.
6
9
MO
RA
L
0.
19
ON
E
O
R
G
0.
80
CA
RE
E
R
0.
20
C
h
i
-
Squa
r
e
=
5
8
.1
3
,
d
f
=
1
1
,
P
-
v
a
l
u
e
=
0
.
0000
0,
R
M
S
E
A
=
0.
166
0.
71
0.
91
0.
83
0.
56
0.
9
0
0.
45
0.
90
0.
94
0.
97
0.
89
Fi
gu
re
4.
C
o
nfi
r
m
a
t
o
ry
Fact
or
A
n
al
y
s
i
s
O
r
ga
ni
zat
i
onal
C
o
m
m
i
tm
ent
of
N
u
rses a
n
d M
i
d
w
i
v
es at
t
h
e
H
o
s
p
i
t
a
l
(n
=
15
6)
B
a
sed on
Fi
g
u
r
e 3, val
u
e
o
f
st
anda
rdi
z
e
l
o
adi
n
g fact
o
r
≥
0.50 m
eant that all indicators
and
sub-
i
ndi
cat
o
r
s we
r
e
val
i
d
a
nd
rel
i
a
bl
e. The
r
e
b
y
,
t
h
e com
p
on
en
ts of org
a
n
i
zatio
n
a
l co
mm
i
t
m
en
t were affectiv
e
commitment, norm
ative
commitment, and c
ontinua
nce c
o
mmitm
ent.
3.
4.
2.
CFA of
Compliance of
Nurs
es and
Midwiv
es on
Bl
ood Transfusion
P
r
ocedure
Com
p
liance of nurses
and m
i
dwi
v
es
on the
blood
tra
n
sfusi
o
n procedure
s
measured the c
o
m
p
liance
of p:
bl
oo
d sa
m
p
li
ng (S
AM
PLI
N
G
)
, se
ndi
ng
bl
o
od sam
p
l
e
s t
o
t
h
e B
l
oo
d B
a
n
k
H
o
s
p
i
t
a
l
(SEN
D)
,
bl
oo
d
acceptance
from
Blood Bank Hos
p
ital (ACCEPT),
blood
inse
rt pre
p
a
r
ation
(PREP
A
RE), blood
insert
i
m
p
l
e
m
en
tatio
n
(INSERT). R
e
su
lt of co
nfirmato
ry
f
actor
an
alysis w
a
s pr
esen
ted in
Figu
re 5
SA
M
P
L
I
N
G
0.
2
3
SE
N
D
0.
4
6
AC
CE
P
T
0.
5
8
P
R
E
P
ARE
0.
2
3
IN
S
E
R
T
0.
3
5
CM
P
L
I
ANCE
1.
0
0
C
h
i
-
S
qua
r
e
=
4
.
1
7,
df
=
5
,
P
-
va
l
u
e
=
0.
5
2
506,
R
M
S
E
A
=
0.
0
0
0
0.
8
8
0.
7
4
0.
6
5
0.
8
8
0.
8
1
Fi
gu
re
5.
C
o
nfi
r
m
a
t
o
ry
Fact
or
A
n
al
y
s
i
s
C
o
m
p
l
i
a
nce
of
N
u
r
s
es an
d M
i
dwi
v
es
o
n
t
h
e
B
l
o
o
d
Tra
n
s
f
u
s
i
o
n
Procedu
r
at th
e Ho
sp
ital (n
=
1
56)
Figure
5 s
h
owes that the
val
u
e
of standardize
loading fa
ctor of
each indicator
was
> 0.50. T
h
e
m
eani
ng
was
val
i
d
an
d rel
i
a
bl
e;
Thu
s
, t
h
e
vari
a
b
l
e
com
pone
nt
com
p
l
i
a
nce p
r
oce
d
ure
of
bl
o
od t
r
a
n
sfusi
o
n
w
a
s co
m
p
lian
ce p
r
o
c
ed
ur
e: (1)
b
l
o
o
d
sam
p
lin
g
(
S
A
M
PLI
N
G
)
,
(2
)
send
ing
b
l
o
o
d
sam
p
les to
th
e Blood Ban
k
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
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:
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2-8
8
0
6
Org
a
n
i
z
at
i
o
n
a
l
C
o
m
m
i
t
m
e
n
t
C
a
n
I
m
pr
ove
C
o
m
p
l
i
a
nce of
Bl
oo
d Tra
n
sf
us
i
on Proce
d
ure (
E
di
Murw
a
n
i
)
18
9
Hos
p
ital (SE
N
D), (3)
blood accepta
nce from
the Blood Ba
nk
Hos
p
ital (ACCEP
T
), (4 ) bl
ood insert
pre
p
arat
i
o
n
(P
R
E
PAR
E
) a
n
d
(5
)
bl
o
o
d
i
n
se
r
t
im
pl
em
ent
a
t
i
on
(
I
N
S
ER
T)
.
3.
4.
3.
An
al
ysi
s
of
S
t
ructur
al
Mo
d
e
l
(Ful
l
SE
M)
B
a
sed
on
ana
l
y
s
i
s
st
ruct
ur
a
l
equat
i
o
n m
odel
i
n
g
a
new
m
odel
was f
o
u
n
d
. T
h
e m
odel
was
a
com
p
l
i
a
nce m
o
del
o
f
n
u
rses
a
n
d
m
i
dwi
v
es i
n
t
h
e
bl
oo
d t
r
a
n
sf
usi
o
n
p
r
oce
d
u
r
e.
It
was
pr
esent
e
d
i
n
Fi
g
u
r
e
6.
Fi
gu
re
6.
C
o
m
p
l
i
a
nce M
odel
of
N
u
rses a
n
d
M
i
dwi
v
es
i
n
t
h
e B
l
oo
d T
r
a
n
sf
usi
o
n P
r
oced
u
r
e
Fi
gu
re 5 s
h
o
w
ed t
h
at
(1
) C
o
m
p
li
ance of n
u
rses a
n
d m
i
dwi
v
es i
n
t
h
e
b
l
oo
d t
r
ans
f
usi
o
n p
r
oce
d
ure
was a
ffect
e
d
b
y
:
(a)
Un
der
s
t
a
ndi
ng
o
f
nu
rs
es an
d m
i
dwi
v
es in
th
e in
stru
ctio
n of the lead
er to
carry
o
u
t
of
bl
o
o
d
t
r
a
n
sf
usi
o
n
p
r
o
ced
ure
.
(
b
) M
e
m
o
ry
of
nu
rses a
n
d m
i
dwi
v
es
ab
o
u
t
bl
oo
d t
r
ans
f
usi
o
n
pr
oce
d
u
r
e;
(c
) J
o
b
sat
i
s
fact
i
on o
f
nu
rses an
d m
i
d
w
i
v
es;
(
d
) O
r
g
a
ni
zat
i
onal
co
m
m
itm
ent
of nurses a
nd m
i
dwi
v
es
, wi
t
h
re
gar
d
(e
)
Pers
onal c
h
ara
c
teristics of n
u
r
ses an
d m
i
dwives.
(2
) Pe
rs
onal characteristics of
nurses a
n
d m
i
dwives pa
ths t
o
com
p
l
i
a
nce of
n
u
rses
an
d
m
i
dwi
v
es i
n
t
h
e
bl
o
o
d
t
r
a
n
sfusi
o
n
p
r
oced
ure
t
h
r
o
ug
h t
h
e
un
de
rst
a
n
d
i
n
g
a
n
d
m
e
m
o
ry
were
st
ro
nge
r t
h
an
j
o
b
sat
i
s
fact
i
o
n
and
o
r
gani
zat
i
onal
c
o
m
m
itm
ent
pat
h
s.
(
3
)
C
ont
ri
but
i
o
ns
effect
of
varia
b
les sim
u
ltaneously
to c
o
m
p
liance by
25%.
B
a
sed o
n
t
h
e a
n
al
y
s
i
s
of t
h
e
st
ruct
u
r
al
m
odel
of o
r
gani
zat
i
onal
com
m
itm
ent
,
nu
rses a
nd m
i
dwi
v
e
s
had si
gni
fi
cant
negat
i
v
e e
ffe
ct
on t
h
e c
o
m
p
l
i
a
nce i
n
t
h
e
bl
o
od t
r
a
n
s
f
u
s
i
on
pr
oce
d
u
r
e
.
B
a
sed o
n
t
a
bl
e 2,
cont
i
n
ua
nce co
m
m
itm
ent
had si
gni
fi
ca
nt
ne
gat
i
v
e ef
fect
o
n
com
p
l
i
a
nce nu
rsi
n
g pe
rs
on
nel
i
n
pre
p
a
r
at
i
on t
o
en
ter i
n
to
t
h
e
p
a
tien
t
's b
l
oo
d. In
th
is d
i
ssertatio
n
,
c
ontinuance c
o
mmitments of
nurses
and
m
i
dwives were
been i
n
fl
ue
nce
d
by
t
h
e pers
o
n
al
characteris
tics of nurses
and m
i
dwiv
es, continuance c
o
mmitments had an
avera
g
e val
u
e in the
m
e
dium categor
y
(
8
0
.
00
%). T
h
i
s
w
a
s due t
o
s
u
p
p
o
r
t
e
d
by
an avera
g
e val
u
e of t
h
e
o
p
i
n
i
on
of nu
rses an
d
m
i
d
w
iv
es of th
e state
m
en
t was fo
ll
o
w
s. (1
) It
wou
l
d
b
e
b
e
tter if so
m
e
o
n
e
was still
work
i
n
g
in th
e
o
r
g
a
n
i
zatio
n throug
hou
t h
i
s/
her career (i
n
the low category); (2
) Th
e
d
e
sire to
rem
a
in
work
i
ng
at
t
h
e
hos
pi
t
a
l
t
o
pa
rt
i
c
i
p
at
e i
n
devel
opi
ng
a
career
(i
n t
h
e
m
e
di
um
cat
egory
)
. R
e
s
u
l
t
s
o
f
t
h
i
s
st
u
d
y
su
pp
o
r
t
e
d
A Three-C
o
mp
on
en
t Mo
d
e
l o
f
Org
a
n
i
zation
a
l Co
mmit
m
e
n
t, wh
ich
stated
th
at th
e co
mmit
m
en
t co
n
tin
u
a
n
ce
had
n
o
effect
o
r
a si
gni
fi
cant
negat
i
v
e e
ffect
on
wo
r
k
be
ha
vi
o
r
s (at
t
e
n
d
a
n
ce, OC
B
an
d p
e
rf
orm
a
nce), i
f
i
t
was
affected
by the
pers
onal cha
r
acteris
tics, alte
rn
ativ
es, and
i
n
v
e
stm
e
n
t
s. In co
n
t
rast, affectiv
e co
mmit
m
e
n
t o
f
nu
rses a
n
d m
i
dwi
v
es
had
n
o
t
bee
n
a
ffect
ed t
o
t
h
e c
o
m
p
liance of
nurses
and m
i
dwives i
n
the
blood
t
r
ans
f
usi
on
pr
oced
u
r
e [
16]
.
It
di
d
not
s
u
p
p
o
r
t
e
d M
e
y
e
r
Joh
n
P
., et
al
.
(2
00
2
)
,
whi
c
h st
at
ed t
h
at
a
ffect
i
v
e
Understanding
H 8
0.
96/2.
06
H4
-0
.9
7
/
-1
.6
0
H 1
-
0
.
25 /-
2.
46
R²=0.
25
Job Sat
i
sf
act
i
on
H 2
-
1
.
15/
-
1
.
78/
H 6
-
0
.
36/
-
2
.
15/
H 5
0.
73/4.
70
Co
m
p
liance
proc
edure of
nurses and
m
i
dw
ives in
t
h
e blood transf
usion
Blood sam
p
ling
Blood sam
p
le delivery
Blood acceptance
Blood insert
preparat
ion
Blood insert
i
m
ple
m
enta
tio
n
P
ersonal
characteristic
H 7
0.
96/2.
00
Org
a
n
i
za
ti
on
al c
o
m
m
i
tm
ent of
nurse
s an
d m
i
d
w
ive
s
Affective c
o
mm
itm
e
nt
Norm
ative com
m
i
tm
ent
C
o
ntin
u
an
ce
co
mmi
t
m
e
nt
H 3
0.
85/2.
63
Mem
o
ry
Notice:
Significant
:
Not signifikan:
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
18
3 – 1
9
2
19
0
co
mmit
m
en
t h
a
d
po
sitiv
e effect sign
ificantly o
n
wo
rk
b
e
h
a
v
i
ors
(atten
d
a
n
ce, OCB
an
d p
e
rfo
r
m
a
n
ce).
Af
fect
i
v
e c
o
m
m
i
tm
ent
had i
n
fl
uence
d
t
o
t
h
e c
o
m
p
l
i
a
nce of
n
u
rse
s
an
d
m
i
dwi
v
es i
f
i
t
had i
n
fl
uenc
ed
by
pers
o
n
al
cha
r
a
c
t
e
ri
st
i
c
and
w
o
r
k
i
n
g e
x
peri
e
n
ce, t
h
ere
we
r
e
su
pp
o
r
t
e
d
by
j
o
b
sat
i
s
fact
i
o
n,
j
o
b
i
n
vol
ve
m
e
nt
,
an
d
o
c
cup
a
tion
a
l co
mm
i
t
m
e
n
t; b
ecau
s
e
o
f
affectiv
e co
mmit
m
en
t in
th
is stu
d
y
was
on
ly in
flu
e
n
c
ed b
y
job
sat
i
s
fact
i
on.
J
o
b
i
n
vol
vem
e
nt
and
occu
pat
i
onal
com
m
itm
en
t were
no
t inv
e
stig
ation
yet. Similarly, th
e
resu
lts
of t
h
is study st
ated that the
norm
ative commitment did
not af
fect the c
o
m
p
liance of
nurses a
n
d m
i
dwives i
n
th
e b
l
o
o
d
tr
an
sf
u
s
i
o
n
pr
o
c
edur
e. I
t
d
i
d
no
t su
ppo
r
t
Meyer
Jo
hn
P., et al.
(
200
2)
,
w
h
ich
stated
th
at no
rmativ
e
co
mmit
m
en
t h
a
d
sign
ifican
t
p
o
s
itiv
e effect
o
n
wo
rk
b
e
h
a
vio
r
s (atten
d
a
n
c
e, OCB and
p
e
rfo
r
m
a
n
ce) if i
t
was
i
n
fl
ue
nce
d
by
pers
o
n
al
chara
c
t
e
ri
st
i
c
s, soci
al
i
zat
i
on expe
r
i
ences, an
d o
r
gani
zat
i
o
nal
i
nvest
m
e
nt
[16]
.
In t
h
i
s
stu
d
y
n
o
r
m
ativ
e co
mmit
m
en
t w
a
s inf
l
u
e
n
c
ed b
y
p
e
r
s
o
n
a
l ch
ar
acter
istics
of
nur
ses an
d mid
w
iv
es thr
ough
th
e
un
de
rst
a
n
d
i
n
g
of
nu
rses a
nd
m
i
dwi
v
es i
n
t
h
e l
eaders’ i
n
st
r
u
ct
i
on t
o
car
ry
out
t
h
e
bl
o
od t
r
ans
f
usi
o
n p
r
o
cedu
r
e
an
d m
e
m
o
r
y
o
f
nur
ses an
d
mid
w
iv
es abou
t b
l
o
o
d
tr
an
sf
u
s
ion
p
r
o
c
ed
ure, as
well as jo
b satisfaction, wh
ile
soci
al
i
zat
i
on e
xpe
ri
ences
, a
n
d
or
ga
ni
zat
i
o
n
a
l
i
nvest
m
e
nt
h
a
d
not
bee
n
st
u
d
i
e
d.
4.
CO
NCL
USI
O
N
Co
m
p
lian
ce o
f
nu
r
s
es an
d m
i
d
w
i
v
es
on
th
e
b
l
oo
d tr
an
sfu
s
i
o
n pro
cedur
e
had
n
o
t
b
e
en
p
e
r
f
ect i
n
th
e
m
oderate category.
It was m
easure
d
fr
om
com
p
li
ance of
n
u
r
ses a
nd m
i
dw
i
v
es in the procedure
of
(1)
blood
sam
p
ling, (2)
blood sam
p
le delivery t
o
t
h
e
Blood Ba
nk Hos
p
ital, (3)
a
cceptanc
e
of t
h
e
blood from Blood
B
a
nk H
o
s
p
i
t
a
l
,
(4 ) bl
oo
d i
n
s
e
rt
pre
p
arat
i
o
n
,
(5
) bl
o
o
d
i
n
s
e
rt
im
pl
em
ent
a
t
i
on. Per
f
ect
com
p
l
i
a
nce pre
v
ent
e
d
n
ear-
m
iss an
d
ad
v
e
r
s
e ev
en
ts, so as to su
ppor
ted
p
a
tien
t
safety p
r
o
g
r
a
m
.
Th
er
ef
or
e, co
m
p
lian
ce of
n
u
r
s
es and
m
i
dwi
v
es o
n
b
l
oo
d
t
r
a
n
s
f
usi
o
n pr
oce
d
u
r
es n
eeded
t
o
be
i
m
pr
o
v
ed
.
The
or
gani
zat
i
onal
c
o
m
m
i
tment
o
f
n
u
r
s
es
and m
i
dwives
(m
easured from
affective commitment,
norm
ative commitm
ent, and c
o
ntinua
nce
comm
itm
ent)
, had a m
ean
value
in the m
e
diu
m
category;
or
ga
ni
zat
i
onal
com
m
i
tm
ent
of n
u
r
s
es a
nd
m
i
dwi
v
es
had
si
gni
fi
ca
nt
ne
gat
i
v
e ef
fect
o
n
t
h
e c
o
m
p
l
i
a
nce
o
f
nu
rses an
d m
i
dwi
v
es i
n
t
h
e bl
o
od t
r
a
n
sf
usi
on
pr
oced
u
r
e.
B
u
t
t
h
e orga
n
i
zat
i
onal
com
m
i
tm
ent
of nu
r
s
es and
midwives ca
n im
prove com
p
liance nur
ses
and m
i
dwi
v
e
s
i
n
t
h
e
bl
o
o
d
t
r
ans
f
usi
on
p
r
oce
d
ure i
f
a
f
fect
i
v
e
com
m
i
tm
ent
and
n
o
r
m
a
ti
ve com
m
i
tm
ent
of
nu
rses
an
d m
i
dwi
v
es
i
m
prove
d.
Affective com
m
itment and norm
a
t
i
v
e com
m
i
tm
ent
of n
u
r
ses an
d m
i
dwi
v
es nee
d
e
d
t
o
be u
p
g
ra
de
d
to
su
ppo
r
t
i
n
creased
co
m
p
lia
n
ce
o
f
nur
ses an
d m
i
d
w
iv
es
on
b
l
oo
d tr
an
sfusio
n pr
o
c
edu
r
es in
or
d
e
r
to sup
por
t
p
a
tien
t
safety.
Efforts to inc
r
ease affec
tive commitment of nurses and midwive
s
are as follows: (1) increasing the
pers
o
n
al
chara
c
t
e
ri
st
i
c
s of n
u
rses a
nd m
i
dwi
v
es (i
ncreas
e un
derst
a
ndi
n
g
of
nu
rses a
nd m
i
dwi
v
es i
n
t
h
e
l
eaders
’
i
n
st
r
u
ct
i
on t
o
car
ry
out
bl
o
od t
r
a
n
sf
usi
o
n
pr
oce
d
u
r
e an
d m
e
m
o
ry
o
f
n
u
r
ses
and m
i
dwi
v
es
abo
u
t
bl
o
o
d
t
r
a
n
sf
us
i
o
n
p
r
oce
d
ure
)
by
way
o
f
t
h
e i
m
pl
em
ent
a
t
i
o
n
o
f
k
n
o
wl
e
dge
m
a
nagem
e
nt
. K
n
o
w
l
e
d
g
e
m
a
nagem
e
nt
consi
s
t
s
of :
(a)
t
h
e est
a
bl
i
s
hm
ent
o
f
com
m
it
tees bl
o
o
d
t
r
an
s
f
usi
on
h
o
s
p
i
t
a
l
s
, (
b
)
pre
p
a
r
at
i
on
o
f
t
r
ai
ni
n
g
m
odul
es bl
o
o
d
t
r
a
n
sf
usi
o
n,
(c) ca
rr
y
i
ng o
u
t
t
h
e t
r
ai
ni
ng
o
f
bl
oo
d t
r
a
n
sf
usi
o
n
o
n
o
ffi
ce
rs
wh
o
carry
out
t
h
e
p
r
oce
d
ure
o
f
bl
o
o
d
t
r
ans
f
usi
o
n,
(
d
)
an
i
n
c
r
ease i
n
wo
r
k
c
u
l
t
u
r
e
com
m
it
t
ee bl
oo
d t
r
a
n
s
f
u
s
i
o
n;
(
2
)
m
oni
t
o
ri
ng a
n
d eval
uat
i
on
o
f
pat
i
e
nt
safet
y
bl
oo
d t
r
a
n
sf
usi
o
n t
h
ro
u
g
h
t
h
e reco
r
d
i
n
g
of re
p
o
rt
i
n
g
t
h
at
i
s
accom
p
anied
by a program
of re
pairs
&
follow-up; (3)
an increas
e in jo
b satisfaction (inc
rease motivator
fact
or
s and m
a
i
n
t
e
nanc
e fact
o
r
s) by
:
(a) t
h
e e
v
al
uat
i
o
n o
f
pe
rf
orm
a
nce and
pr
o
v
i
d
i
n
g fee
d
back
, (b
) a pr
o
g
ram
of
rec
o
gnition and prom
otion,
(c)
a
n
incre
a
se in the
working rela
tions
hip am
ong em
ployees, (d) training
su
perv
ision
o
f
th
e h
e
ad
o
f
th
e
ch
am
b
e
r, (e)
im
p
r
ov
em
en
t
of work
ing
co
nd
itio
ns, (f) ev
alu
a
tion
o
f
h
o
s
p
ital
p
o
licy, (g)
th
e ev
alu
a
tion
o
f
salary,
and (h) an
inc
r
ease
i
n
job security;
(4) socialization
e
xpe
riences
(inse
r
t
soci
al
i
zat
i
on p
r
o
g
ram
pol
i
c
i
e
s and
p
r
oce
d
u
r
es f
o
r
bl
o
o
d
t
r
ans
f
usi
o
n
s
i
n
ori
e
nt
at
i
o
n
pr
og
ram
new n
u
r
si
n
g
pers
o
nnel
(n
u
r
ses an
d m
i
dwi
v
es)
an
d
(5
)
or
gani
zat
i
o
nal
i
n
vest
m
e
nt
(i
nse
r
t
com
p
l
i
a
nce nu
rses a
n
d m
i
dwi
v
es
on
bl
oo
d t
r
ans
f
usi
o
n
pr
oce
d
u
r
es i
n
t
o
p
r
o
g
r
a
m
rem
unerat
i
o
n)
.
Effo
rts to
im
p
r
ov
e t
h
e
n
o
rmativ
e comm
itment of nurse
s and m
i
dwives are
as
follows: (1) T
h
e
in
crease in
job satisfactio
n inv
o
l
v
e
d th
e
inc
r
ease of m
o
tiva
t
or
factors a
n
d
ma
intenance
fa
ctors. It
is inc
r
eased
b
y
ways
of (a) evalu
a
tion
of p
e
rform
a
n
ce and
p
r
o
v
i
d
i
ng
feedb
a
ck
;
(b) a
p
r
og
ram
o
f
recog
n
ition
an
d
pr
om
ot
i
on;
(c
)
an i
n
crease
i
n
t
h
e w
o
r
k
i
n
g
rel
a
t
i
ons
hi
p am
on
g em
pl
oy
ees;
(
d
)
su
per
v
i
s
ory
t
r
ai
ni
n
g
f
o
r h
e
ad
of
ward
; (e) im
p
r
o
v
e
m
e
n
t
o
f
work
i
n
g
co
nd
ition
s
; (f) ev
al
u
a
tio
n
o
f
h
o
s
p
ital p
o
licy; (g) th
e ev
alu
a
tion
of
salary;
and (h) a
n
i
n
crease in
job
security
. (
2
) T
h
e i
n
c
r
ease i
n
j
ob i
n
v
o
l
v
em
ent
i
s
ha
d
bee
n
do
ne
by
wa
y
s
of
i
m
p
l
e
m
en
tin
g
th
e program
in
vo
lv
em
en
t o
f
em
p
l
o
y
ees. It is
in
i
m
p
r
ov
em
e
n
t p
r
og
ram
s
relatin
g
to
th
e safety o
f
th
e p
a
tien
t
s that u
n
d
e
rg
o
e
s b
l
oo
d
tran
sfusio
n
s
t
h
ro
ugh
the activ
ities o
f
th
e Quality Co
n
t
ro
l Circle (QCC),
and
(3) a
n
inc
r
ease in
occ
u
pational comm
itm
ent or
wo
rk commitments or
profe
ssional co
mmit
m
en
t. It is
reco
g
n
i
zed as
a pr
o
f
essi
o
n
(s
al
ary
base
d
on
educat
i
o
n
n
u
rs
i
ng st
a
ff /
n
u
r
se
s an
d m
i
dwi
v
e
s
) a
nd t
h
e
pr
of
essi
on
is u
s
ed
for life.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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S I
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225
2-8
8
0
6
Org
a
n
i
z
at
i
o
n
a
l
C
o
m
m
i
t
m
e
n
t
C
a
n
I
m
pr
ove
C
o
m
p
l
i
a
nce of
Bl
oo
d Tra
n
sf
us
i
on Proce
d
ure (
E
di
Murw
a
n
i
)
19
1
ACKNOWLE
DGE
M
ENTS
Aut
h
o
r
s e
x
p
r
e
ssed t
h
an
ks a
n
d hi
g
h
ap
p
r
eci
at
i
on t
o
t
h
e m
o
t
h
e
r
,
hu
sba
n
d
,
chi
l
d
ren
,
gra
ndc
hi
l
d
,
an
d
fam
i
ly fo
r t
h
eir
p
r
ayers, m
o
ral, and
m
a
teria
l
sup
p
o
r
ted
.
Th
en to
a larg
e
fam
i
ly o
f
d
r
. Saifu
l
Anwar M
a
lan
g
Hos
p
i
t
a
l
,
East
Java
, I
n
do
ne
si
a;
i
n
pa
rt
i
c
u
l
ar n
u
r
s
es a
n
d
m
i
dwi
v
es
an
d al
l
pe
rs
on
s
wh
o s
u
pp
o
r
t
e
d t
h
i
s
researc
h
. T
h
e
Ken
d
e
d
es F
o
u
ndat
i
o
n, M
a
l
a
ng
, East
Java
,
In
d
onesi
a,
w
h
i
c
h ha
d s
u
p
p
o
rt
ed t
h
e f
u
ndi
ng
of t
h
i
s
research
. Th
e p
r
esen
ted
in
this scien
tific article were h
a
d
resu
lted
of th
e
authors
’re
searc
h
, the
r
e were
no ha
d
in
ter
v
en
ted of
an
y org
a
n
i
zatio
n.
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BIOGRAP
HI
ES OF
AUTH
ORS
Edi Murw
ani
Doctoral Cand
id
ate, Doctoral Studies Program of
Health S
c
i
e
n
ces
, F
acu
lt
y of
P
ublic Heal
th,
Airlangga University
, Surab
a
y
a
,
Indonesia.
Full Duty
of Head Subdivision of Research and
Development dr. Saiful
Anwar Malang Hospital,
East Jav
a
, Indon
esia. Division
ex
pertise of Hospital Man
a
gement.
Lecturer Program Diploma
3
Midwifer
y
STI
K
es
Kendedes
Malang, East
Java, Indonesia
Chairman of
the
STIKes Kended
e
s
Malang
, East Java, Indonesia
Em
ail:
edim
urwani@gm
a
il
.com
Ste
f
anus Su
pr
iyanto
Professor with e
xpertise
Field
of
Adm
i
nistrative
Scien
ces
and He
al
th Polic
y,
Pl
a
nni
ng a
n
d Eva
l
uat
i
on Spec
ia
l
St
udie
s
,
Ma
rke
t
i
ng Ma
na
geme
nt
a
nd Qua
lity
Ma
na
ge
me
nt
Services, at Airlangga University
, Surabay
a
, Ea
st Java, Indonesia. Lect
urer Doctoral Studies
P
r
ogram
of Heal
th S
c
ien
ces
,
F
a
c
u
lt
y of P
ubl
ic H
eal
th, Air
l
angg
a
Univers
i
t
y
S
u
rab
a
ya,
E
a
s
t
J
a
va
,
Indonesia.
Consultant and s
p
eaker of Mar
k
eting Hospital,En
trepren
e
urship,
Health Insuran
c
e, Funding and
Budgeting
S
y
stem and th
e Reg
i
o
n
al Companio
n
Development
o
f
Regi
onal Health
S
y
stem.
Chairm
an of M
a
s
t
ers
P
r
ogram
in Health S
e
rv
i
ces
M
a
nagem
e
n
t
, F
acul
t
y
of P
ublic Hea
lth
,
University
of
Airlangga, Sura
b
a
ya,
East Java, Ind
onesia.
Em
ail:
stefpri49
@
gm
ail.com
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I
S
SN
:
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06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
18
3 – 1
9
2
19
2
Suhar
t
o
Professor with expertise Field
of
Medicine
in
dr
.
Soetomo, and Airlangga
University
, Surab
a
y
a
,
Indonesia.
President Director of Tropical
I
n
fectious Hospital, Surab
a
y
a
,
East Java, Indon
esia.
Lecturer
Doctoral Studies Program of Hea
lth Scien
ces, Faculty
of Public
H
ealth, University of Airlangga
in Surabay
a
, East Java, Indonesi
a. Ch
airman o
f
the Master
of
Nursing Scien
ce, Facu
lty
o
f
Nursing, Univer
sity
of Air
l
angg
a in
Surabay
a
, East Java, Indon
esia.
Ch
airman of
MKDU PPDS
I Medicin
e
Facu
lty
of Med
i
cin
e
,
University
of
Airlangga, East Java, Indon
esia. C
h
airman of
the
Medical Advisor
y
DPM BPJS,
East Jav
a
, In
donesia. Stering
members of INA Respond
Res
earch
and D
e
velopm
ent Co
m
m
ittee in
coop
erat
ion with
the
United S
t
a
t
es
. D
ean of M
e
d
i
cin
e
of Faculty
, Nahd
latul Ulama Univ
ersity
, Surabaya, Indon
esia.
Email: divtrop
i
n
@
y
a
hoo
.com
Evaluation Warning : The document was created with Spire.PDF for Python.