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Work Related Stress and Job Performance among Staff Nurses Introduction
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Abeer Mohamed Zakaria
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Work Related Stress and Job Performance among Staff Nurses
1
Manal Mahmoud Ibrahim, 2 Abeer Mohamed Zakaria, 3 Asmaa Moustafa Abdel-Ghani
1
2
3
Head nurse , Bani-Ebeid specialized Hospital
Professor of Nursing Administration, Faculty of Nursing – Mansoura University,
Lecturer of Nursing Administration, Faculty of Nursing – Mansoura University.
Abstract
Background: : Work-related stress has a significant implications
for organizations and
individuals, which in turn impacts the job performance of staff nurses. Aim: To assess the
relationship between work related stress and job performance among staff nurses. Methods:
A descriptive, correlational design was utilized with a sample of (128) staff nurses at Dikirnis
General Hospital. Tools of data collection were Work Related Stress Questionnaire and
Observation Checklist of Nurses Performance (OCNP ) Results: The majority of studied staff
nurses (71.1%) had moderate level of perception toward work related stress and more than
half (56.8%) of studied staff nurses had fair level of job performance Conclusion: There was
no statistically significant correlation between work related stress and job performance of the
studied staff nurses .Recommendations: Establish a committee represented from staff nurses
that discuss nursing staff problems, Continuing education programs for nurses should include
topics about work related stress and its preventive measures to decrease its negative outcomes
and Enhance job performance of nurses by creating and organizing training program on job
performance as a managerial skill for head nurses to maintain improving patient care.
Keywords:
work
related
stress
1
,
job
performance,
staff
nurses
Introduction:
Nursing is an extremely delicate and demanding profession, and nurses are frequently exposed to
circumstances that might negatively impact their physical and mental health. Due to their dangerous line
of work, nurses are frequently exposed to infections and injuries that can be fatal. Nurses are responsible
for caring for the sick, dealing with emergencies, dealing with a complex system of power, dealing with
people who are dying, and dealing with complicated equipment (Al- Nuaimi,et al ,2021).
Nursing is a profession that is high stress by its very nature. Few people encounter extreme misery,
loss, and dying on a daily basis like nurses face. Many nursing tasks are uninteresting and boring. By
conventional standards, many are nasty, others downright repulsive, while others are frequently
demeaning, and some are just plain scary (Qattan ,2017) .
Stress is as an environmental stressors that has a great impact on person and causes psychological
and physical consequences. When coping mechanisms are ineffective, people experience stress
reactions. The welfare of employees is thought to be profoundly impacted by the environment of work.
The work environment has an impact on and puts a significant amount of stress on healthcare
employees, especially those in the nursing profession (Yuwanich, Sandmark, & Akhavan 2016).
Work related stress is the un favorable physical and psychological reaction brought on by an
imbalance between perceived resources and perceived demands and capacities of workers to meet such
demands. When a worker’s requirements, resources, or capabilities are not met by the demands of their
job, or when those demands are exceeded, or when a worker’s or group’s knowledge or coping
mechanisms do not align with the organizational culture of the enterprise, these situations result in workrelated stress which is influenced by work organization, labor relations and work design (Eldin , Sabry,
Abdelgwad & Ramadan ,2021) .
Work related stress has a significant influence on both individuals and organizations. Despite the
fact that it impacts all hired professional, the burden on healthcare practitioners is too great. Work
related stress lead high blood pressure, cardiovascular problems, musculoskeletal problems and
substance abuse. Furthermore, it contributes significantly to injuries and psychological disorders .
Additionally, it decrease organizational commitment, job satisfaction, healthcare quality, Organizational
effectiveness, work related delay .absenteeism and staff turnover (Girma , Nigussie, Molla & Mareg
,2021).
Staff nurses stand out among those who are susceptible to experiencing work related stress. Staff
nurses are directly in charge of patient care, hospital department management, and a variety of
bureaucratic and administrative tasks. Nursing is one of the professions most at risk for stress and
sickness inside the hospital setting because nurses must deal with unhealthy working conditions
including job overload and repetitive duties. Work related stress influences daily activities of staff
nurses because it causes bodily, mental, cultural and social harm, and can have many effects on
2
employees, their families, their workplaces, and the communities in which they live and work and their
performance ( Santana ., Ferreira & Santana 2020).
Performance is important for people , businesses and educational institutions and also nurses
experience motivation, contentment, and self-efficacy when duties are completed effectively . Work
related stress is one of the main significant causes that have an adverse effect on performance and
lowers job satisfaction and output quality as a result of the nurse’s direct stress exposure ( Danish, et al
2019)
Job Performance of nurses is a significant issue for all health care organizations. The level of
nursing performance and healthcare system reflects the quality of delivered care, patient outcomes and
the achievement of organizational goals. Job performance is the ability of a person to effectively carry
out their responsibilities and roles associated to providing direct and indirect patient care which
classified into patient related and no-patient related nursing activities (Al-Makhaita, Sabra,& Hafez,
2014). In general, it is a phenomena with multiple dimensions affecting by patients‟ high expectations,
job stress, advanced technology, quality control and heavy duties and responsibilities (Samiei, Abdul
Manaf R, Ismail, & Kandasamy, 2016).
In every health care organizations, nurses are the largest work force in the health care delivery
system who performing nursing activities from the aspects of nursing professional development,
teaching/collaboration, interpersonal relations/communications, leadership, critical care, and
planning/evaluation (Islam, Khatun &Nesa, 2019). These can be categories as patient related and nonpatient related nursing job performances. Patient related job performances are performing technical
procedure (oral suctioning, tracheotomy and catheter care, dressing change), give emotional support to
dying patient and family ,managing emergency and critically ill patients, teaching patients and family
members. On the other hand, the non-patient related job performances are praise to subordinate, delegate
responsibility based on priority, guide others for nursing care plan, maintain high standards of
performance (Islam, Khatun &Nesa, 2019).
The impact of high levels job performance leads to increase productivity as well as quality of
service and patients care. Inadequate job performance is thought to pose a risk to the wellbeing of
patients and increased mortality and morbidity(Al-Makhaita, Sabra,& Hafez, 2014). Hospitals like
every other organizations, cannot be successful without effective performance. Therefore performance
appraisal is crucial to notify higher authorities about the nurses’ performance while performing their
duties and to ensure that the quality of care is met (Islam , Khatun,& Nesa 2019).
Performance management is a set of procedures that guarantees the accomplishment of
organizational objectives in an efficient way and continual performance enhancement for the best
results. Performance management is a process that involves taking decisive action to increase employee
productivity through teamwork and personal capabilities, as well as the productivity of the company as a
whole. Performance management procedures include employee training and development, performance
appraisal and evaluation mechanisms to offer a suitable evaluation and feedback mechanism that can
3
improve the abilities and skills of employees of companies to enhance performance and continue to
produce at a high rate. The strategic goal of the human resources department is to promote the balanced
development of behaviors which foster excellent job performance and to assure the creation of a positive
environment that fosters high productivity and organizational sustainability (Dixita & Sharma, 2021).
Therefore, the hospitals need to maintain safe environment and respect the rights, responsibilities
and needs of all health professionals. Specifically, they need to consider the importance of staff nurses’
health for good job performance like the availability of behaviors that promote health and the provision
of relevant training and information on health concerns (Mokhtar & Mohamed, 2017).
Significance of the study:
Intensive care units, operation room, emergency department and high risk units deals with very
critical and dangerous cases that require high level nursing care by staff nurse in such condition staff
nurse more liable to work related stress.
Work-related stress can result in a variety of challenges that divert nurses’ attention from their
work to other situations and times, which will have a detrimental influence on the nurses’ level of
performance and the efficiency with which the staff nurses can accomplish their job-related roles and
responsibilities (Zahran et al.,2017). So that the aim of this study is to assess the relationship between
work related stress and job performance among staff nurse .
Aim of the study:
This study aims to assess the relationship between work related stress and job performance among
staff nurse.
Research Questions:
RQ1: What is the level of work related stress?
RQ2: : What is the level of staff nurses’ performance ?
RQ3: Is there a relationship between work related stress and job performance
among staff nurse?
Methods:
Research design:
This study’s methodology was a descriptive correlational.
The study setting :
The study was carried out in all ICU,OR ,emergency department ,high risk (incubation unit) at
Dikirnis General Hospital that provide health services to seven centers in the Dakahlia governorate,
which is in Egypt’s Delta region’s north-eastern area. It provides inpatient care to approximately 912
patient and Outpatient care to approximately 3000 patient monthly. Dikirnis General Hospital occupied
with 227 beds.
Participants of the study:
4
Participant of the current study included all available staff nurses working at all ICU,OR
,emergency department ,high risk (incubation unit) and willing to participate in the study during the
time of data collection and their total numbers were (128) staff nurses at Dikirnis General Hospital .
. Tools of data collection: Two tools were had to get the data:
Tool (I) :Work Related Stress Questionnaire:
It was developed by Giorgi , Arcangeli & Cupelli (2013) and modified by the researcher by
changed the negative items into positive items . It was used to measure work related stress. It consists of
two parts:
Part 1: this part include personal characteristics of staff nurses as age , marital status ,educational
qualification ,year of experience, and unit.
Part 2: this part include 25 items that include five stress-related factors or dimensions which are: role
ambiguity (5 items) , colleagues‟ support (5 items) , supervisors‟ support (4 items) , job demands (6
items) , job control (5 items) used a five-point Likert scale from absolutely agree to absolutely disagree
.(1) Absolutely Agree ,(2)Agree ,(3)Neutral ,(4)Disagree ,(5) Absolutely Disagree .
After recording the response to positively worded items, the questionnaires gives a total score,
whereby a higher score indicates a greater degree of work related stress.
Scoring system:
The total score was classified as low(75%).
Tool (II); Observation Checklist of Nurses Performance (OCNP):
It was developed by (Fekry, 2015) to assess performance of staff nurses. It included (71) items
categories under 9 main dimensions which are: leadership (7 items), Psychosocial individual (14 items),
communication (11 items), general patient care (13 items), vital signs (3 items), medication (7 items),
patient status (5 items), planning and evaluation (4 items) and dressing (7 items). Observation checklist
scored on the basis of yes, no and not applicable for each activity. “Yes” scored (one point), “no” scored
(zero), and “not applicable” omitted from the calculation.
Scoring system:
The total score was classified as poor(75%).
Validity and reliability:
Data collection tools translated into Arabic by the researcher and tested for its content relevance
and validity through a panel of five expertise from the Faculty of Nursing Mansoura University`s
nursing administration department who assessed the tools for, applicability transparency,
comprehensiveness, understanding, and ease for application and based on their responses simple
modifications were made. This modifications were related to grammatical language and rephrasing of
5
some sentences. Reliability test of the study tools, Work Related Stress Questionnaire and Observation
Checklist of Nurses Performance (OCNP) were assessed by Cronbach’s Alpha. Reliability was
calculated and showed (0.89), (0.70), respectively .
Pilot study:
A pilot study was conducted on 10% ( 14) staff nurses of the study sample to evaluate the
transparency, feasibility of the statement and to determine the required time to fill-in questions . Staff
nurse who participated in the pilot research were excepted from the total study sample And necessary
modification includes clarification, and rephrasing were made based on their responses.
Ethical Consideration:
The researcher obtained ethical approval from the Research Ethics Committee of the Faculty
of Nursing, Mansoura University. Formal approval was obtained from administrator of Dikirnis General
Hospital to carry out the research. Explanation of the purpose and the nature of the study were
performed by the researcher to all staff nurses involved in the study. Participation in research was
voluntary, each staff nurse was made aware of their ability to reject or participate or leave at any
moment without giving reasons. The study had no negative effect on the subjects. The collected data’s
confidentiality was guaranteed, findings were incorporated into the essential studies as well as for
publications and educational purposes in the future.
Field work:
Data collection process spanned three months from the start of August to the end of October
2021. The aim of the study and how to fill tool was explained by the researcher. The researcher collected
data about work related stress through distributing questionnaire to staff nurses during work hours in
morning and afternoon shifts. Give 5-10 minutes to fill the questionnaire sheets and observation
checklist which utilized to assess nurses performance done by the researcher through observing staff
nurse individually. This needed the researcher to attend in the unite for long time at different days in
morning and afternoon shift . The number of questionnaire sheets collected from staff nurses per day
ranged from 3-4 sheets. The researcher went to Dikirnis General Hospital three days per week.
Statistical analysis:
The gathered data was arranged, tabulated, and statistically examined by using SPSS software
(Statistical Package for the Social Sciences, version 26, SPSS Inc. Chicago, IL, USA). The normality
assumption was accepted. As a result, percentage and frequency were utilized to describe categorical
data. For the representation of continuous variables, the mean and standard deviation were utilized. To
examine any changes between the two means of continuous variables, an independent t-test was utilized.
ANOVA-test was utilized to test the changes between more than two means of continuous variables.
The association between two categorical variables was tested using the chi-square test. The relationship
between two continuous variables was tested using the Pearson correlation coefficient test. Statistically
significant was judged as (p-value 10
Mean±SD
Unit
Emergency unit
Cardiac intensive care unit
General intensive care unit
Operating unit
Neonatal intensive care unit
38
13
29.7
10.2
14
10.9
27.01±3.01
5.14±4.07
30
19
27
20
32
8
23.4
14.8
21.1
15.6
25.0
69.05
63.80
70
57.13
60
55.18
46.92
50
41.36
40
30
20
10
0
Figure (1): Mean percentages and rank of work related stress as perceived by the studied staff nurses
(n=128)
9
71.1 %
28.1%
0.8 %
Low (75%)
Figure (2): Levels of work related stress as perceived by the studied nurses (n=128)
90
80
70
60
50
40
30
20
10
0
81.0
85.0
65.45
45.50
49.85
51.69
47.4
37.86
34.0
22.0
Figure (3) Mean percentages and rank of job performance among the studied staff nurses (n=128).
10
39.8 %
56.8 %
3.9%
Poor (75%)
Figure (4): Levels of job performance among the studied staff nurses (n=128)
11
r=-0.08 / p=0.39
Figure (5) Correlation between work related stress and job performance of the studied staff nurses
(n=128)
Discussion:
By its very nature, nursing is a profession that is exposed to a significant amount of stress. Work
related stress is a reality in all occupations, but nurses seem to endure higher levels of it than other
healthcare professionals. Stress is a natural aspect of life and is essential for overcoming obstacles
encountered on a daily basis. When the stress reaction is out of proportion to the difficulty of the
struggle, issues start to arise. Excessive stress levels lead to high degree of employee sickness,
unhappiness, absenteeism, significant staff turnover , reduced productivity, inadequate performance and
as consequence, trouble in supplying patients with quality care when it is not controlled and the
organization’s failure to provide protection and assistance to nurses (Ransford, 2018). Hence, the target
of the current study was assessing the relationship between work-related stress and job performance
among staff nurses.
12
Regarding to the first variable investigated in the current study was work related stress. The
current study showed that the studied staff nurses had moderate level toward their perception of work
related stress. This could be linked to lack of management support, a lack of job control and a heavy
workload, all of which could contribute to conflict between staff nurses and others at workplace . In
addition to , nursing is a challenging profession, and nurses are more likely than other healthcare
workers to encounter stress-inducing situations.
This finding was corresponding with a study conducted by Abu Shusha (2018) who stated that
a moderate level of work-related stress was experienced by more over half of the nurses in his study
about work-related stressors and its effect on quality of nursing care at Benha University Hospital.
Besides, this finding in agree with research carried out at Benha University Hospital by Morsi, &
Ebraheem, (2020) who assessed work-related stressors and coping strategies and its relation to job
performance and perceived organizational support among critical care nurses and revealed that most of
nurses perceived moderate level of work-related stress.
This findings was supported by the study conducted at Benha University by Ahmed ,Mourad
,Zaki, & Mohamed (2022) who examined relationship between occupational stress, burnout and job
performance among nurses working in ICU and stated that all surveyed nurses were exposed to various
degree of stress. The greatest percentage of surveyed nurses reported high perception level of
occupational stress and the lowest percent reported mild occupational stress level . In addition, less
than one quarter of the study participants perceived moderate level of occupational stress.
On the contrary, this finding was disagreed with Umann , Guido, & Silva, 2014) who examined
Stress, coping and presenteeism in nurses assisting critical and potentially critical patients and
discovered that more than half of nurses experienced low work related stress level . In addition, it was
mismatched with a study conducted by Johansen & Cadmus (2016) that assessed conflict management
style, supportive work environments, and the experience of work stress in emergency nurses and found
that most nurses experienced low level of work-related stress, with the fewest percentage experiencing
moderate to high level of stress.
Furthermore, the current study findings conversed with the research conducted by Fanani , Tualeka
& Sarwiyata (2020) who concluded that the nurses at the Malang Islamic Hospital reported low to
moderate levels of job stress in his study ” Job Stress Level Among Islamic Hospital Nurses”.
Regarding the dimension of work related stress , supervisor support dimension was the
highest mean percentage which indicated that it was one of the fundamental sources of work related
stress related to lack of supervisor support and may due to lack of supervisor’s knowledge and
experience about motivation of staff, and leadership capabilities and problem solving skills. This
findings agreed with a study conducted in Ghana by Donkor (2013) who examined effects of stress on
the performance of nurses and concluded that problems with supervisors, lack of support and
disagreements with colleagues were the most common sources of nursing stress.
Additionally, a study by Higazee, Rayan, & Khalil (2016) who examined the relationship
between job stressors and organizational support among Jordanian nurses conformed that there was
13
inverse correlation between the nurses’ reported stress and organizational support . Also, this result was
in accordance with (Nappo 2020) who found that in his research ”Job stress and interpersonal
relationships cross country evidence from the EU15: a correlation analysis”s” , support and help given
by one‟s manager reduces the likelihood of experiencing job stress .
Following supervisor support as the highest mean percentage in the current study was job
control or autonomy came next. This may be due to decrease nurses’ freedom and ability to select the
methods to conduct to achieve the tasks, decrease a certain amount of options to decide how to continue
with work and they can’t plan or schedule the work. This finding was matched with a study carried out
in Italy by Giorgi, Arcangeli , Ariza-Montes, Rapisarda & Mucci (2019) who found that nurses
respondents had higher average values for the lack of job control and the lack of support from
colleagues in his study ”Work-related stress and its association with recovery experience”.
Role ambiguity was the lowest mean percentages which indicated that staff nurses have a little
a clear idea about the objectives and goals of department and they nearly know their responsibilities and
duties clearly .This result was agreed with Gharib, Jamil , Ahmad, & Ghouse, (2016) who revealed
that role ambiguity dimension came in the final after workload and role conflict in his study ” The
impact of job stress on job performance: A case study on academic staff at Dhofar University”.
This result is inconsistent with Islam, Alam, Keramat, Murshid, Haque, Kabir & Khan (2021 )
who found that hospital nurses who experienced significant levels of job and task ambiguity were found
to be more stressed in his study about working conditions and occupational stress among nurses in
Bangladesh.
Also disagreed with a research conducted in Malaysia by Yousefi &Abdullah (2019) who
examined ”The impact of organizational stressors on job performance” and revealed that role ambiguity
is the important factor in predicting organizational stressors that have a negative impact on performance.
Moreover this finding not matched with a study of Akkoç , Okun, & Türe (2021) who demonstrated
that the most significant factors contributing to nurses’ increased work-related stress are role ambiguity
followed by role conflict and workload.
Following role ambiguity as the lowest mean percentage in the current study was colleagues
support came next in this study. This may due to colleagues are interested in hearing about problems at
work and respect each other which lead to work cooperation and less stress . This finding disagreed with
a research done at Benha University Hospital by Morsi, & Ebraheem, (2020) who found that staff
nurses with high level of work related stress suffered from lack of colleagues’ support at work .
And result with (Nappo 2020) concluded that the probability of experiencing work related stress
is likely to increase if you receive assistance and support from colleagues. However, continuing to
cooperate and getting along with coworkers decreases the probability of experiencing stress.
Regarding to the second variable investigated in the present study was job performance . The
current study indicated that the studied staff nurses had moderate level of job performance. This can be
as a result of the availability of training programs that promote the ongoing acquisition of new skills and
knowledge and the presence of good communication skills between staff nurses and other healthcare
14
personnel. This finding was identical with the study conducted at Benha University Hospital by Ahmed
et al., (2022) who revealed that two thirds of nurses performed nursing activities at good level , while
one third of them performed poorly.
This finding was consistent with Al- Homayan, Shamsudin, Subramaniam & Islam (2013)
who conducted a study on Saudi Arabia’s public hospitals’ nurses about impacts of job performance
level on nurses and found that the performance of nurses was moderate . In the same respect agreed
with Mohamed & Ghalab (2022) who conducted a study at Tanta Emergency Hospital and results
revealed that nearly half of the staff nurses performed their job at moderate level overall.
In addition to , this result agreed with Mahmoud , Elsaid & Kamel (2020) who reported that
nurses performed their jobs at a high level in his study” Effect of workplace bullying on nurses’ job
performance” at Benha University . Respectively Safarpour, Sabzevari & Delpisheh (2018) who
revealed that nurses performed their jobs well at high levels in his study about occupational stress, job
satisfaction and job performance among hospital nurses in Ilam, Iran.
In the same line this result was corresponding with Ahmed, Sleem & Kassem( 2015) who
assessed the effect of working condition and fatigue on performance of staff nurses at Mansoura
University Hospital and illustrated that staff nurses at Mansoura University Hospital had good level of
performance. In addition, another study conducted by Zahran , Berma , &Abu El-enin (2017) at
Belkas Central Hospital found that the majority of staff nurses had satisfactory performance level .
On the contrary, outcomes of the current study was interfered with a research conducted by Sleem&
El-Sayed (2011) who examined the effect of job conscientiousness on job performance and indicated
that the staff nurses’ performance at Mansoura University Hospital’s surgical units was inadequate. This
may be due to the fact that a lack of coworkers and a shortage of staff nurses causes a rise in workload
and a decline in productivity.
In this repect, these results interfered with the study conducted by Ibrahim, El Sayed, Attala &
Elmezin (2016) who examined the relationship between head nurses’ leadership styles and staff nurses’
job performance and showed that the performance scores among the staff nurses who working at
Mansoura Emergency Hospital, affiliated to Mansoura University Hospital, were comparatively low,
and all nurses„ performance was inadequate and requires improvement. Moreover, the study conducted
by Morsi, & Ebraheem, (2020) at Benha University Hospital found that about half of critical care
nurses performed their nursing activities at low level.
Regarding to dimensions of performance: the finding of this study indicated that
medication as a dimension of performance had the highest mean percentage . It could be because nurses
have a major responsibility to administer medications, which is a crucial component of regular nursing
practice. This result was matched with Ahmed, Sleem & Kassem ( 2015) who concluded that good
performance of medication administration among nurses working at Main Mansoura University
Hospital’s general medical and surgical units. This finding also, agreed with Shehata , Sleem , El-sayed
& Ramada (2011) who illustrated that medication administration was the most significant dimension
among the nurses working at Mansoura University Hospital.
15
On the contrast, Yousef (2001) reported that nurses working in the pediatric and adults cardiosurgical units at Ain Shams University Hospital had poor performance related to medication
administration. Also, this finding disagreed with Hajibabaee,, Salehi Kamboo, Faghanipour,
Ashrafizadeh & Haghighi Zadeh, 2019) who reported that poor performance of medication
administration among nurses working in pediatric wards in hospitals affiliated with Ahwaz University
of Medical Sciences, Iran related to the incidence of nurses‟ medication errors was somewhat higher.
Following medication as the highest mean percentage in the current study was vital signs came next
in this study . This might be as a result of vital signs being routine tasks that were measured on a regular
basis to evaluate the patient’s health status and physicians being concerned about it throughout the
medical round. This finding matched with the study performed by Sleem& El-Sayed (2011) who found
that vital signs were the greatest among staff nurses.
In the same view this finding agreed with Ahmed, Sleem & Kassem ( 2015) who indicated that the
nurses working at Main Mansoura University Hospital’s general medical and surgical units had good
performance of vital signs . Also, a research conducted by Al- Homayan et al., (2013) who found that
vital signs were done at good level by nurses that working in public sector hospitals in Saudi Arabia .
Opposite to these findings a study conducted by Mahmoud (2000) who stated that vital sign
performance among Ain Shams University nursing interns was poor in his study ” The performance of
nursing interns related to basic nursing procedures”.
The current study showed that planning and evaluation was the lowest mean percentage as a
dimension of performance which indicated poor performance of this dimension . This may be due to
lack of knowledge and skills about planning and evaluation ,neglect evaluation of patients outcomes
and some of nurses didn’t accept criticism . This result was agreed with (Islam, Khatun, & Nesa,2019)
who found in his study ” Job Performance of Clinical Nurses at Tertiary Level Hospital in Bangladesh”
that planning and evaluation dimension came in the final after interpersonal relationship and
communication, critical care and teaching/collaboration that is patient related job performance of
clinical nurses.
This finding disagreed with Yuxiu , Kunaviktikul &Thungiaroenkul (2011) who conducted a
study at two university hospitals in Yunnan Province, China, and showed that the level of planning and
evaluation performance was moderate.
Moreover, this result disagreed with study carried out by Al-Makhaita, Sabra,& Hafez( 2014)
who concluded that Planning and evaluation were performed at a moderate level. Again , this result
interfered with the study conducted by Ahmed, Sleem & Kassem ( 2015) who stated that there was
good performance of planning and evaluation of nurses working at Main Mansoura University Hospital’s
general medical and surgical units.
In addition , this result disagreed with Mohamed & Ghalab (2022) who concluded that material
planning and coordination ,staff relations, communication, communication with patients and nursing
care plan are the main source of moderate performance among nurses working at Tanta Emergency
Hospital.
16
Following planning and evaluation as the lowest mean perc
