|Year : 2018 | Volume
| Issue : 3 | Page : 258-267
Impact of quality of working life on the psychological well-being and marital adjustment among female nurses
Safaa Mohamed Metwaly1, Mona Mohamed Abd El-Maksoud2
1 Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Zagazig University, Zagazig, Egypt
2 Department of Community Health Nursing, Faculty of Nursing, Helwan University, Cairo, Egypt
|Date of Submission||15-Aug-2018|
|Date of Acceptance||16-Oct-2018|
|Date of Web Publication||28-Dec-2018|
Safaa Mohamed Metwaly
Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Zagazig University, Zagazig
Source of Support: None, Conflict of Interest: None
Background Nurses are one of the most diverse and largest workforces in the health-care system. Their work usually affects different concerns of their life. The aim of the present study was to investigate the impact of quality of working life (QoWL) on the psychological well-being (PWB) and marital adjustment among female nurses.
Research design A descriptive-analytical study design was used to carry out this study.
Setting This study was conducted at all maternal and child health centers in Zagazig City.
Patients and methods A purposive sample composed of 208 female nurses who were working in the previously mentioned settings were recruited. Tools of data collection: four tools were used for data collection. They were the sociodemographic data sheet, the QoWL scale, Ryff’s PWB scales, and ENRICH marital satisfaction scale.
Results The study results revealed that more than two-thirds of female nurses had a low QoWL and all of them had stress at their work. Majority of the studied nurses showed low level of PWB and marital adjustment. Also, there was positive correlation between QoWL, psychosocial well-being, and marital adjustment among female nurses with high statistical significance.
Conclusion It was concluded that most of the studied samples had a low level of QoWL, PWB, and marital adjustment and there was statistically significant positive correlation between these variables.
Recommendations This study recommended that further researches are needed to identify the predicted factors of low QoWL and factors that affect PWB and marital adjustment.
Keywords: female nurses, psychological well-being and marital adjustment, quality of work life
|How to cite this article:|
Metwaly SM, El-Maksoud MA. Impact of quality of working life on the psychological well-being and marital adjustment among female nurses. Egypt Nurs J 2018;15:258-67
|How to cite this URL:|
Metwaly SM, El-Maksoud MA. Impact of quality of working life on the psychological well-being and marital adjustment among female nurses. Egypt Nurs J [serial online] 2018 [cited 2019 Aug 17];15:258-67. Available from: http://www.enj.eg.net/text.asp?2018/15/3/258/248959
| Introduction|| |
Nursing is a very stressful profession. In the nursing work, nurses not only have a lot of things to do but also are compelled to make some decisions. Most of nurses have many things they are accountable for, and to make quick decisions regarding patient care and well-being (Said et al., 2015). Also, Beatrice et al. (2008) revealed that nurses are called on to deliver ‘life-saving’ therapy, knowledge, assurance as well as emotional support. The frequency and intensity of these highly stressful workplace interactions may put a significant emotional burden on them.
Quality of work life (QoWL) is a helpful condition and environments of a workplace that support and enhance workers’ satisfaction by offering them prizes, job security, and growth opportunities (Al-Qutop and Harrim, 2011). Amin (2013) added that the QoWL can increase employees’ loyalty to the organization, promote confidence between employees and supervisors, decrease stress, and intensify wellness.
QoWL influences different aspects of nurses such as their production, patient satisfaction, commitment, and quality of life (Rai, 2013). In the same line, Nowrouzi (2013) indicated that the QoWL affects not only job satisfaction, but also satisfaction in other life domains including leisure, family, economic well-being, health, housing, relationships, education attainment, society engagement, neighborhood relationships, spiritual well-being, the environment, and cultural and social status. According to Suresh (2013), the most important predictors that have direct influence on the quality of nursing working life are health and well-being, job security, job satisfaction, proficiency development, work–life balance, control over workload, nursing leadership guidance, lack of autonomy, appropriate job implementation, feedback, and opportunities for improvement.
Marital adjustment is harmony and empathy between both spouses in attaining common goals in life which lead to marital satisfaction. Marital adjustment lets both spouses disregard conflicts and solve them with a tosuitable methods and achieve topositive feelings (Yeganeh and Shaikhmahmoodi, 2013). As indicated by Nadam and Sylaja (2015) the success of one’s marital life depends mainly on the success in marital adjustment by both spouses. They revealed that the six factors which affect marital adjustment are: (a) feeling for the spouse, (b) harmonious relationships, (c) communication, (d) reciprocal understanding, (e) sexual relations, and (f) other factors related to the marital life. In the same context, Sahul and Singhll (2014) revealed that marital adjustment is a process, the outcome of which is influenced by a degree of problematic marital differences, interpersonal tension, and personal anxiety, marital satisfaction, dyadic cohesion, and agreement on significant matters of marital functioning.
Working women have to face many problems resulting from multiple roles which may affect marital and family life. Professionals like nurses are much liable to have dissatisfaction from marital relationship, especial if they work in primary health-care settings, as they are engaged in a stressful job which has many difficulties related to long hours of work, low salaries, contact with the public working all time (Abdul Azeez, 2013). Moreover, nurses and here spend most of their time in their place of work and have massive responsibilities, so they cannot handle all their responsibilities and roles at home. As a result, they may face many problems in their roles as wives and this may be a cause of marital dissatisfaction (Gharibi et al., 2016).
Psychological well-being (PWB) is identified as a positive functioning of an individual as well as the quality of his/her life. It includes happiness, peace, accomplishment, and life satisfaction (Gupta and Nafis, 2014). In the same context, Garg and Rastogi (2009) revealed that PWB is concerned with an individual’s appraisal of his/her constant happiness; satisfaction with his/her physical and mental health, and how it correlates to some psychosocial factors such as life or work satisfaction. PWB affects an individual’s work life, personal life, and general well-being, and in return, occupational satisfaction. The individual should be free from stress, tension, anxiety, boredom, disappointment, loneliness, and isolation in order to have good PWB (Al-Qutop and Harrim, 2011). Nurses’ PWB and health appear to be related to their abilities to fine tune their professional and private personal responsibilities (Beatrice et al., 2008). Moreover, high workloads and low levels of salaries, control, and value resemblance were associated with greater worker distress and lower PWB (Burke et al., 2011). Working outside home influences the PWB of married women. These effects on the PWB may result from less assistance from a partner, more responsibilities, and difficulties at home and at workplace (Sadiq and Ali, 2014).
In Egypt, maternal and child health centers is the basic health unit and the first point of contact between the community and the health-care system, which provide a large part of the basic health care to the public. It provides different health-care services as prevention programs, treatment of simple diseases, maternal and child health services such as promotive, preventive, curative, and rehabilitative health care for women in the childbearing period, infants and preschool children, immunization, in addition to environmental health, and public health education (MOHP, 1999). Among different specialties in family health-care settings, nurses have a major role among other health-care providers; consequently, they must be equipped with the necessary knowledge, training, and experience to manage the patient properly (Almalki et al., 2012).
In the few studies conducted in Egypt, which explain the QoWL, majority of them came from hospitals based on hospital nurses (Shazly and Fakhry, 2014; Morsy and Sabra, 2015). Even the previous studies were done in maternal and child health centers focused on nurses’ job satisfaction only and omitting the importance of QoWL. There is a real need to conduct further studies of QoWL in different health settings, as family health-care facilities focus especially on public health nurses, who is accompanied by a high level of physical, social, and emotional, as well as intellectual work demands. Hence, it is important to determine how the QoWL impact their homelife and PWB.
| Aim|| |
This study aimed to investigate the impact of QoWL on PWB and marital adjustment among female nurses.
- What is the relationship between QoWL and PWB of female nurses?
- What is the relationship between QoWL and marital adjustment of female nurses?
- What is the relationship between PWB and marital adjustment of female nurses?
| Patients and methods|| |
A descriptive, analytical study design was used to accomplish the aim of this study.
This study was conducted at all maternal and child health centers (nine) in Zagazig City, Sharkia Governorate.
Sampling and populations
The present study was carried out on a purposive sample composed of all female nurses (208 nurses), who were working at the previous mentioned settings, according to the following inclusion criteria:
- Married for at least 1 year.
- Working in her position for at least 1 year.
- Accept to participate in the study.
Tools for data collection
A self-administered questionnaire that included four standardized tools were utilized in this study. They are:
- Tool I: sociodemographic data sheet which was utilized to assess the sociodemographic characteristics of the studied nurses. It constitutes the variables like age, residence, level of education, year of work experience, nature of husband’s work, monthly income, duration of marriage, number of children, and family type.
- Tool II: The QoWL scale was developed by Van Laaret al.(2007) to assess QoWL. This scale consisted of 34 items divided into seven domains as follows. (a) employee engagement (eight items), (b) control at work (five items), (c) home–work interface (five items), (d) general well-being (seven items), (e) job and career satisfaction (two items), (f) working conditions (three items), and (g) stress at work (four items).
The reliability of that tool was tested by measuring its internal consistency. It demonstrated a good level of reliability with Cronbach’s alpha based on standardized items 0.79.
The overall scale uses a five-point Likert scale in which 1 point is ‘strongly disagree;’ 2 points, ‘disagree;’ 3 points, ‘neutral;’; 4 points, ‘agree;’ and 5 points, ‘strongly agree.’ The total scores ranged from 34 to 170 points. Higher scores will signify elevated degree of QoWL. This scale has reversed sentence numbers (7, 9, 18, 22, 30, and 31) that were scored 5, 4, 3, 2, and 1 for the following responses ‘strongly disagree,’ ‘disagree,’ ‘neutral;’ ‘agree,’ and ‘strongly agree.’
Tool III: Ryff’s PWB scales was developed by Ryff and Keyes (1995) to assess PWB by using a series of 42 statements reflecting the six areas of PWB: autonomy (seven items), environmental mastery (seven items), personal growth (seven items), positive relations with others (seven items), purpose in life (seven items), and self-acceptance (seven items). This scale has good level of reliability with Cronbach’s alpha 0.75.
Respondents rate each statement on a scale from 1 to 5, with 1 indicating strong disagreement and 5 indicating strong agreement. For each category, a high score indicates that a respondent has a mastery of that area in her life. Conversely, a low score shows that the respondent struggles to feel comfortable with that particular concept. This scale has negative or reverse sentences no: 3, 5, 10, 13, 14, 15, 16, 17, 18, 19, 23, 26, 27, 30, 31, 32, 34, 36, 39, and 41. They were scored as follows: that is, if the score is 5 in one of these items, the adjusted score is 1; if 4; the adjusted score is 2, and so on…
Tool (IV): ENRICH marital adjustment scale was developed by Fowers and Olson (1993), to assess the marital adjustment. The scale consists of 15 items. Items 1, 4, 6, 9, and 13 constitute the idealistic distortion scale. The remaining items are in the marital status. The Cronbach’s alpha reliability of this scale is 0.66.
Respondents rate each statement on a five-point Likert scale; 1 indicating strong disagreement and 5 indicating strong agreement. Items 2, 5, 8, 9, 12, and 14 were reverse coded. Recode negatively phrased items (i.e., if it is marked 5, it would be scored 1: if it is marked 4, it would be scored 2: a 3 remains unchanged), then summing the appropriate items for each scale.
Adequacy of QoWL, PWB, and marital adjustment was as follows: the cutoff point was 60%, whereas more than 60% was considered as high and less than or equal to 60% was considered as low.
Content validity and reliability
The tools were translated into Arabic language using the translation and back-translation technique to ensure their original validity. Before data collection, the researcher established content validity of the tools by asking five experts from the academic staff at the faculty of nursing, Zagazig University (psychiatric nursing and community nursing departments) who revised the tools for clarity, relevance, applicability, comprehensiveness, understanding, and ease of implementation. Their comments generally around vocabulary and sentence construction were used to revise the tools. Reliability of the tools was assessed by Cronbach’s alpha test in statistical computer package for the social sciences, V.20 (SPSS Inc., Chicago, Illinois, USA).
A pilot study was conducted on 10% of the total studied nurses to evaluate the clarity of the tools, as well as to estimate the time needed for data collection. The necessary modifications were performed, namely, rephrasing and utilizing simpler semantic for the statements. These nurses were excluded from the main study sample.
Fieldwork: first, the researcher contacted all maternal and child health center directors and head nurses to obtain their consent to carry out the study. The head nurses helped the researchers in distributing the questionnaires. The participants were selected purposively. The self-administered questionnaire was given to each participant individually after being informed about the purpose of the study and taking verbal consent for participation in the study. Each their participant took about 20–30 min to complete the questionnaire. Data collection was carried out over a 3-month period from October to December 2017.
Administrative and ethical consideration
An official permission was obtained from the dean of the faculty of nursing to the directors of all maternal and child health centers Zagazig University explaining the aim of the research to get the permission for data collection. The researchers met with the nurses individually to explain the purpose of the study and to obtain verbal their consent to participate. They were informed about their rights to refuse or withdraw from the study, with no untoward consequences. Clear instructions on how to complete the questionnaire were given. Confidentiality of the collected information was assured that it would be used only for the purpose of scientific research. In addition, the data collection forms were kept anonymous.
The collected data were organized, tabulated, and statistically analyzed using the statistical computer package for the social sciences, version 20. Qualitative data were represented as frequencies and percentage. For quantitative data, mean and SD were computed. Independent t test and analysis of variance were used for quantitative normally distributed data for detection difference between two different groups. Correlation between variables was evaluated using Pearson’s correlation coefficient (r). Significance was adopted at P value less than 0.05 for interpretation of results of tests of significance.
| Results|| |
[Table 1] showed the sociodemographic characteristics of studied samples, the table clarified that the age of the studied sample ranged between 21 and 43 years with a mean of 29.64±5.58 years. It also revealed that more than half of them had a Bachelor’s degree (51.4%) and only 3.8% had a postgraduate education. Years of experience was less than 18 years in 80.3% of the studied nurses.
This table indicates that the mean of their marriage duration was 8.52±5.82 years, and more than half of the studied sample (60.6%) had more than two children. In more than half of the studied sample (58.7%) their husbands worked just half-day and their monthly incomes were sufficient. About two-thirds (65.4%) of the studied sample lived with extended family, and 59.1% of them lived in rural areas.
[Table 2] clarifies the QoWL dimensions. The table shows that about two-thirds (66.3%) of nurses had low level of total QoWL, and the lowest QoWL were under stress conditions (100%), home–work interface (67.8%), and control of work (63%), while they had a high quality of work in job satisfaction, general well-being, and work condition and employee engagement (78.8, 72.1, 61.5, and 60.6%, respectively).
|Table 2 Mean score of quality of working life among the studied sample (N=208)|
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[Table 3] indicates that the majority of nurses (86.5%) had a low level of total PWB, and only a quarter of the respondents had high level of autonomy and personal growth (24.5, 25.5%, respectively) but other areas of PWB were very low.
[Table 4] represents marital adjustment among the studied nurses. This table displayed that the majority of nurses (94.7%) had low level of the total marital adjustment and only quarter of them were adjusted in id distortion (24.5%), while 3.4% were adjusted with their marital status
[Table 5] presents that PWB had highly statistically significant positive correlation with QoWL, and marital adjustment (r=0.316, 0.410), respectively. The table also revealed that the QoWL had a statistically significant positive correlation with the marital adjustment of the studied sample (r=−0.189).
|Table 5 Correlation matrix of patients’ scores of quality of work life, psychological well-being, and marital adjustment (N=208)|
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Concerning the relationship between the nurses’ sociodemographic characteristics and their total score of QoWL, PWB, and marital adjustment ([Table 6]) clarifies that there were statistically significant relationships between studied sample characteristics and PWB especially in age, year of experience, nature of husband’s work, and duration of marriage. Also there were statistically significant relationships between QoWL and age, year of experience, duration of marriage, and family type, while marital adjustment had a statistically significant relationship only with monthly income at P value equal to 0.001.
|Table 6 Relationship between the patients’ sociodemographic characteristics and their total score of quality of work life, psychological well-being, and marital adjustment (n=208)|
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| Discussion|| |
Work and family are two important issues in an individual’s life that can interfere with each other. Women, especially nurses, encounter conflicts between family life and their work. This inter-role conflict is an important source of stress (Rafatjah, 2011). Thus, this study aimed to investigate the impact of QoWL on PWB and marital adjustment among female nurses.
Concerning the QoWL among nurses, the results of this study revealed that about two-thirds of the nurses had a low level of total QoWL. A low level QoWL leads to job dissatisfaction, stress at work, and these consequences have negative effects on the nurse, her psychological status, as well as her home conditions. This result is consisted with the finding of a study done in Egypt among nurses working in Assiut University Hospital by Morsy and Sabra (2015) who found that more than two-thirds of the nurses had low level of QoWL. On the same line, the findings of the study by Almalki et al. (2012) among 508 PHC nurses in Saudi Arabia showed that the nurses were dissatisfied with their work life. Similarly, a study was done in Palestine by Said et al. (2015) who found that most nurses experienced low QoWL. Also, Ramesh et al. (2013) indicated that the QoWL was poor among majority of nurses in a medical college hospital in Bangalore, India.
The stress at work was the lowest subscale of QoWL, where all female nurses mentioned that they had stress at their work; this is probably due to weak relationship, as well as the stress associated with the workload. In addition, there is lack of social support, particularly from supervisors and coworkers. These results were equivalent to the findings of a study on nurses in China by Lin et al. (2013) who reported that the stress at work was very low as compared with the other dimensions. The findings also showed that more than two-thirds of the studied sample had low quality in home–work interface; this might be due to that all nurses in the sample were women and married and the majority of them had children. They would be overloaded with their work responsibilities. In this line a study done in Egypt by Shazly and Fakhry (2014) found that one-third of female nurses had a high level of stress in home/work life (31.7%). Thus, work–life balance was an important factor having an impact on the QoWL of nurses and negatively influenced their lives (Khani et al., 2008). Control work is the third lowest domain among the currently studied nurses, where more than two-third of them had the lowest quality of work in control of work. This may be due to the lack of participation of nurses in decision-making at work, and opportunities for self-development and advancement in their career. Consistently, Shazly and Fakhry (2014) reported that the work control dimension of QoWL was the lowest level as mentioned by the nurses.
The findings of the present study revealed that more than three-quarters of nurses showed satisfaction of their job and had general well-being, as well as high engagement in their work. This means adequacy of the work environment, training, development, facilities, and resources. In the same line, Thakre et al. (2017) reported that 74% of Indian nurses were notably satisfied with their job; this may be because they are allowed to use their skills and abilities while managing patients. In the present study, about two-thirds of female nurses reported high quality of their work condition, which was very important for improving the QoWL. The work environment is a place which consists of safe physical and mental working situations and determines reasonable work hours. This finding was consistent with Thakre et al. (2017) who found that more than half of the nurse perceived that they were satisfied with the dimension of work environment life. Similarly, Almalki et al. (2012) stated that the nurses reported their satisfaction with their work condition.
As regards the PWB of the nurses, the findings of this study revealed that the majority of the studied nurses showed low level of total PWB and all of its subscales. This might be explained by the fact that the nurse is likely to be exposed to a stressful occupation, leading to being dissatisfied with their working lives. This will be associated with diminished nursing staff well-being and organizational outcomes relevant to patient’s care. In accordance with these results, a study was done in Spain by Burke et al. (2012) who reported that the nurses indicate lower levels of PWB. Similarly, the findings of a study done in Turkey by Burke et al. (2010) reported that the level of psychological distress is high among the studied nurses. So it is important to develop the nurse’s career to improve their psychological status. This was in line with Amin (2013) who stated that career development could increase the QoWL of nurses which in turn increases their PWB.
Regarding the marital adjustment of female nurse the results of this study revealed that majority of studied nurses had a low level of marital adjustment. The active engagement of women in the employment sector and their dual role has a significant correlation with marital adjustment, especially in a sector like health. The worked women face more difficulties in their marital and working live because they had more of responsibilities of job, which lead them to suffer from more severe causes of conflicting roles at home and hospital, while on the other side they have to take care of their children, husband, and in-laws and also perform other domestic duties (Rani, 2013). This result was in disagreement with a study done in India on female nurses by Abdul Azeez (2013) who found that major portion of the respondents are moderately satisfied with their marital life.The results of the current study found that there was highly significant positive correlation between QoWL and PWB among studied nurses; this means that improving nurses’ QoWL leading to improvement in their PWB. On the same line, a study was done in Indonesia by Zulkarnain (2013) who found that there was a significant positive correlation between QoWL and PWB. Thus, if the nurses have a good QoWL, they are likely to be satisfied with their well-being. Furthermore, in this study, there was a significant positive correlation between QoWL of nurses and their marital adjustment. This may be due to that the nurse spends most of the time in the workplace and she has many responsibilities, which may affect her roles especially in the home environment, leading to marital dissatisfaction. This finding consisted with the results of other studies in which there was a significant relationship between QoWL and marital satisfaction (Ghaffari and Rezaie, 2013;). This can be interpreted as the high workload of nurses causes physical and psychological problems which lead to marital dissatisfaction; in other words, when an individual’s job interferes with his responsibilities it leads to role conflict and less marital satisfaction.
Also, the result of this study found that there was not any significant relationship between the nurses’ sociodemographic data and their marital adjustment except for the income; this may be due to the fact that when the people have low income, they fail to afford their basic needs. This creates a pressure on their PWB and causes an indirect impact on the QoWL. Especially, when they get married and have children, the economic burden will increase. Similarly, Alipour et al. (2015) found a positive significant relationship between income and marital adjustment among married women in Iran. Financial problems often provide the grounds for the emergence of conflicts among couples and affect their adjustment. This finding was contrary to that of a study done in India on female nurses by Abdul Azeez (2013) who found that there were relationships between different personal variables and their marital adjustment. As discussed in the literature and empirical studies, child rearing is considered as a burden and has a significant influence on the family environment and marital relationship, but in this study results showed that there was no significant relationship between the number of children and marital adjustment. Simultaneously, the type of family and duration of marriage also did not have any influence on marital adjustment. One possible explanation for this result could be that there were different external factors that affect marital adjustment. The results of the study are in line with the findings from a previous study done in Malaysia by Ghoroghi et al. (2015) who claimed that there were no significant differences in marital adjustment with different family types and duration of marriage. Disagreement with the finding of previous research done on married nurses at Nigeria by Oalei and Nathaniel (2016) reported that length of marriage has a relationship with the level of marital adjustment.
Concerning the relationships among the QoWL, PWB, and female nurses’ sociodemographic data, the findings of this study showed that there were statistically significant relationships between age of the nurses year of experience, and their QoWL and PWB. Nurses who have more experience probably had developed better coping skills than those who had a shorter service period, also the nurse with experience, abilities, skills, knowledge, motivations, and less burnout, had successful job performance and better QoWL. On the same line, a study was done in Vietnam by Quang Vo et al. (2015) showed that some of the demographic variables such as age and years of experience affect the QoWL. This finding was consistent with the results of the study done in Tehran by Moradi et al. (2014) who found that there was a significant relationship between QoWL and work experience so that nurses with more work experience had a better QoWL. One of the sources of occupational stress for nurses is a shorter length of work experience. Thus, it seems that nurses with greater work experience feel less burnout and more stability in their job and better QoWL. On the contrary, Nabirye et al. (2011) showed that nurses with more years of experience are more dissatisfied with their QoWL than those with less experience. Also, Nayeri et al. (2011) reported that there was no significant relationship between QoWL and the length of work experience. The results of this study reported significant relationships between duration of marriage and total score of PWB and QoWL. On the contrary, a study was done in India by Divinakumar et al. (2014) who found that there were no significant differences observed between the duration of marriage for nurses and their PWB and job performance.
The results of the current study found that there were statistically significant relationships between QoWL of nurses and their residence type, and are nearly significant with PWB, where the nurse lived with her extended family had a low QoWL than those who lived in the single family. This may explain the workload of household and care of the extended family might put the married female nurses under more stress. Also dual responsibility, criticism from mother-in-law and less cooperation from her might induce frustration, and hopelessness, all of these leading to psychological distress and of course impact on their quality of work. This finding was consistent with Hanif and Naqvi (2014) who found a direct relationship between the increasing involvement of nurses in multiple roles that were performed at the same time and family conflict; these might interfere with their work and affect their PWB. This research provided an initial step in understanding the QoWL and its impact on PWB and marital status of female nurses in maternal and child health settings. All the results which were previously discussed answered the researchers’ questions that there is a statistically significant relationship between QoWL, PWB, and marital adjustment.
| Conclusion|| |
On the basis of the study findings, it is concluded that the studied nurses had low level of QoWL, PWB, and marital adjustment and there was statistically significant positive correlation between these variables among the studied nurses. Also, there were statistically significant relationships with the studied sample characteristics and QoWL and PWB in most of their sociodemographic data, while marital adjustment had a statistically significant relation only with family income.
Based on the results of this study, it was recommended that:
- Develop and implement intervention programs to enhance nurses’ QoWL at maternal and child centers.
- Counseling for nurses’ PWB can help to increase nurses’ motivation.
- Further research to identify the predictors’ factors of low QoWL and factors effect on PWB and marital adjustment.
The researchers acknowledge and appreciate all the nurses participated in this study and all expertise doctors who revised the tools of data collection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]