Mental Pressures Research Articles

National Exam Elimination Policy by Student during The COVID-19 Pandemic

Abstract. This study aims to find out the impact of the elimination of national examinations according to junior high school students during the covid-19 pandemic in Batu. This type of research is descriptive analysis with qualitative approach. Data analysis in this study uses source triangulation. Data analysis is taken by reducing data, summarizing all data results, and presented in narrative form and then concluded. The number of research subjects was 6 junior high school students in Batu, as well as data collection techniques, namely observation and interviews. Data analysis in this study is in the form of presentation of data in a short description. The results of data analysis showed that in the implementation of national examinations there is a positive impact that students are encouraged to actively study and negative impacts that students experience psychological and mental pressures because they have to master the learning materials to be tested. Students' graduation is seen from the national test scores to apply to the intended school. This happens so that a policy arises that is the elimination of national examinations.Keywords: Policies, National Examinations, Students, Covid-19 Pandemic Period.

A Qualitative Study on the Experiences of COVID-19 Ward Nurses in Shiraz, Iran

Background: The psychosocial risks and job stress have been considered as the most important factors affecting the occupational health and safety and, therefore, exerting significant impact on the health conditions of individuals, organizations, and national economy. Objectives: The present study investigated the experiences of the nurses working in COVID-19 wards of specialty hospitals in Shiraz, Iran. Methods: Semi-structured interviews were carried out via telephone. A total of 15 participants (11 nurses and 4 active supervisors of COVID-19 wards) were included in the study. A conventional content analysis was applied. Results: COVID-19 ward nurses had a perception of differentiation because they had experienced difficult conditions and had higher social responsibilities. However, they managed to retain their social responsibilities despite suffering from anxiety and fear, physical and mental pressures, as well as various deficiencies. Four themes including fear and anxiety, burnout, deficiencies, and expectations were explored in this study. Conclusions: Overall, COVID-19 pandemic was found to have posed several challenges for nurses as the front-line staff in Iran. Therefore, it was recommended that necessary measures and strategies should be adopted in order to address these challenges.

Teenager’s Mental Health Status During COVID-19 in Bangladesh

The outbreak of COVID-19 might not have a homogeneous dispersion of its own adverse consequences. Adolescents in the least developed country including Bangladesh who are already underprivileged or fragile predicted to suffer substantial damage and mental health disorders during COVID-19. Adolescents and their families might suffer significantly from a variety of mental health pressures like mood disorders, anxiety, stress, loneliness, depression, and suicidal tendency for children. A systemic literature review throughout PubMed, Google Scholar, and Medline was done to evaluate the research, which covered the years between 2020 and 2022. This manuscript emphasizes how COVID-19 harms children’s mental health. Finally, suggestions for parental care, and mental health care for young children are given. Future studies will concentrate on how well age-appropriate, evidence-based mental health services work.

The Study of the Effect of Occupational Stress on Resilience: Mediating Role of Occupational Engagement (A Case Study: Nurses of Al-zahra Hospital in Isfahan)

Introduction: Considering the high mental pressures on nurses at work, identifying the effective resilience factors is deemed necessary. Therefore, this study aims to investigate the mediating role of occupational engagement in the relationship between occupational stress and resilience among the nurses of Al-zahra Hospital of Isfahan.
 Methods: The present study was a descriptive survey-correlational study. The population of this study included 1700 nurses from Al-zahra hospital in Isfahan city. Based on Cochran’s formula and by convenience sampling method, 200 people (60 men and 140 women) were chosen. Occupational stress questionnaires of HSE, resilience, and occupational engagement were performed on the sample. The collected data were analyzed using SPSS and AMOS software using structural equation modeling.
 Results: The results showed that occupational stress had a negative and significant effect (P <0.001) on the vibration with the mediating role of occupational engagement. Also, occupational stress had a negative and significant (P <0.001) negative effect on occupation and there was a significant and positive effect (P <0.001) on resilience.
 Conclusion: The results indicate that occupational stress affects the resilience, but if the nurses are engaged in their jobs, this effect will reduce and the construct of engagement will act as a mediating variable.

Prevalence and risk factors of nosocomial infections in different wards and seasons in two hospitals in northeastern Iran

The prevalence of nosocomial infections (NIs) is a significant health issue in developing countries, and the increased incidence rate of these infections results in longer hospital stays, more mental pressures, increased treatment costs, and higher antibiotic resistance. The present study aimed to evaluate the prevalence of NIs in two hospitals from 2011-2018. In total, 1123 patients with a history of NIs, as reported in the NIs surveillance systems of the hospitals, were included in the study. Data analysis was carried out by SPSS version 16 using Chi-square tests to evaluate the relationship between hospital wards, age, and gender. The prevalence of NIs was higher in the training hospital than in the social security hospital. Also, the prevalence of NIs decreased from 2011-2017 but has increased since 2018. The highest prevalence of NIs was related to E. coli (9.35%), with gram-negative bacteria having the highest frequency (36.2%). In addition, the most common location of NIs was the ICU (23.95%). In terms of the site of infection, postoperative infections had the highest prevalence (38.91%). The results were indicative of a significant relationship between mean age and various hospital wards. In addition, there was a significant relationship between the hospitalisation ward and gender. Meanwhile, no significant association was found between age and hospitalisation ward (P<0.05). There is a need for periodic training for all hospital-based agents to reduce NIs, especially in wards where invasive measures are used for treatment.

Stress and Job Performance of Healthcare Workers amidst COVID-19 Pandemic: The Mediating Role of Burnout

Healthcare workers in hospitals are one of the frontliners in handling the COVID-19 issue. However, previous studies were mostly directed on doctors and nurses, albeit many other workers are involved in managing the COVID-19 issue at a hospital. Physical and mental work pressures in performing their jobs and responsibilities potentially affect their performance. This study aims to shed some light on the direct influence of job stress on the job performance of healthcare workers during the COVID-19 pandemic with burnout as a mediating variable. This study make use of a cross-sectional approach by employing a questionnaire to gather the data from 194 healthcare workers at Aisyiyah Ponorogo General Hospital Indonesia. Drawing on the Structural Equation Modeling Partial Least Square, the results reveal that (1) job stress has a negative influence on the job performance of the healthcare workers, (2) job stress is proven to have a positive effect on the burnout of the healthcare workers, and (3) burnout is found to partially mediate the effect of job stress on the job performance of the healthcare workers. By referring to the compelling results, valuable suggestions are offered to the hospital managers and further related studies. This study’s results further contribute to providing recommendations for the hospital management as well as the government concerning on factors affecting the healthcare workers’ job performance, especially at the age of a crisis such as the COVID-19 pandemic.

MUSCULOSKELETAL DISORDERS IN OPERATING ROOM: A PHENOMENOLOGICAL STUDY

Aim: The present study sought to understand the semantics of surgical technologists about the causes and factors inducing musculoskeletal disorders in operating room medical staff. Background: The physical health of operating room technologists, affecting the health of patients, causes mental health problems and reduces occupational performance. Methods: A qualitative and phenomenological study was conducted. The statistical population included all surgical technologists of Hamadan University of Medical Sciences, from which 10 individuals were selected by non-probability and snowball sampling methods, and in-depth interviews were carried out for them. Results: In data analysis, the primary code was extracted in the form of 14 sub-themes and 5 main categories, including management factors, facilities, manpower status, destructive factors of the work field, and miscellaneous factors. Conclusion: The operating room medical staff considers muscular discomfort and pain in the head, neck, wrist, back, and legs as skeletal disorder, and they believe that factors such as managerial measures, poor equipment and lack of facilities, manpower status, destructive factors of intensive, long, and repetitive work fields, and some miscellaneous factors are effective in their occurrence. Relevance to clinical practice: As the medical staff are faced with physical, mental, and psychological pressures due to the difficulty of work, lack of facilities, attitudes of supervisors and managers as well as colleagues, this research can be effective and useful in order to introduce more of these dimensions to the relevant authorities.

Impact of the COVID-19 pandemic on the Australian residential aged care facility (RACF) workforce

Objective: We conducted a survey to understand the challenges faced by the staff of residential aged care facilities (RACF), during the COVID-19 pandemic. Background: In the current pandemic, the RACF workforce has been required to work under stressful conditions, with immense mental and physical pressures, resulting in anxiety and stress felt towards their jobs. Study design and methods: We electronically surveyed both clinical and non-clinical staff at public and private RACFs in Australia in June and August 2020. The survey asked a mix of open-ended and closed questions about preparedness for the pandemic, information flow, experience with personal protective equipment (PPE), management of suspected COVID cases, restrictions on visitors, and impact on RACF staff personal and home life. Quantitative data were analysed in SPSS; qualitative data using content analysis. Results: We received 371 responses: 198 from clinical staff and 168 from non-clinical staff. Respondents were between 20–71 years old, and 87% were female most commonly from Victoria (28%) or New South Wales (28%). The majority (80%) felt that Australian RACFs were well-prepared for the pandemic and 87% agreed that relevant healthcare authorities were contactable for information needed. A total of 37% reported challenges in estimating and ordering appropriate quantities of protective equipment. Ninety percent of facilities reported screening residents for possible symptoms and 77% introduced precautions or quarantine measures to protect residents. Most participants (98%) reported their RACF implemented restrictions on visitor access and 43% reported unfair or abusive treatment by family or friends of the residents. Commonly reported personal impacts included: workload increase, stress, emotional toll, family issues and fatigue. Support from colleagues as well as training, de-brief sessions and frequent meetings were identified as helpful facilitators during this time. Conclusion: We identified a wide range of practices and coping strategies among Australian RACFs. Whilst a majority of respondents reported coping well, a large proportion reported struggling both mentally and physically. Factors reported as helpful by the respondents may assist RACFs in planning for future pandemics. Implications for research, policy and practice: Understanding the challenges faced by all levels of staff within RACFs may aid decision-makers on a range of different levels – researchers, aged care providers, local/regional/state health departments and national leaders within government to help inform the development of interventions that may help the sector to recover, as well as prepare for potential future outbreaks. Of particular importance, are interventions or initiatives that focus on supporting the physical and mental health of staff i.e. those that prevent or minimise worker fatigue, emotional burnout and stress. What is already known about the topic? Nursing staff in Australian RACFs did not feel prepared for the COVID outbreak in their workplace. Early in 2020, RACF nurses experienced a greater overall workload and some had their staff hours reduced by their employers due to financial constraints caused by the outbreak. What this paper adds This paper offers a comprehensive insight into how RACF staff coped both individually and as part of the facility overall during the COVID crisis. It identified that a commonly reported source of stress was first-hand verbal abuse from family or friends of residents in response to visitor and lockdown restrictions implemented by the authorities. The paper highlighted that whilst the majority of respondents felt that RACFs were well prepared for managing residents during the pandemic, some facilities experienced significant problems with workloads, PPE and human resourcing. Furthermore, the survey showed that on an individual level, some staff experienced significant mental and physical stress during the outbreak.

The transformation of education during the corona pandemic: exploring the perspective of the private university students in Bangladesh

PurposeIn 2020, the education system was preliminary halted by the COVID-19 crisis and went through radical improvisation, and online-based distance learning was the only plausible initiative to continue educational activities ensuring health guidelines properly. However, in reality, such desperate measure in case of a lower-middle-income developing nation lacking proper structural capabilities raised some issues and concerns for both pupils and mentors, and this study aims to explore the practice of online-based distance learning in private universities of Bangladesh and the challenges associated with it.Design/methodology/approachThis exploratory research is qualitative in nature. A total number of 89 undergraduate level university students from different private universities were divided into two main clusters and interviewed in depth.FindingsThe findings of this paper revealed that common developing country syndromes like improper technological infrastructure development, limitation to devices or internet accessibility and financial hindrances can disrupt the harmony of the online learning experience. Also, the lack of tech literacy has created a huge tension and psychological inertia among both the teachers and the students.Social implicationsThe coronavirus pandemic event, with its dreadful influence, is creating immense mental pressures for students to cope well with the online learning system. Comprehending the underlying challenges affiliated with online-based distance learning and enabling faculties or respected personnel with training and development programs to handle impediments better way, this learning initiative can ensure the best outcomes.Originality/valueThe significance of this study lies in comprehending the feasibility of online-based education regarding lower-middle-income developing nation context and the realism of such learning process's acceptability considering its actual effectiveness.

المخدرات وتأثيرها على الفرد والمجتمع

Abstract The problem of drug addiction for individuals, especially young people, is one of the most dangerous pests that cause many problems in various health, social and psychological aspects facing every society, but rather the whole world. The phenomenon of drug addiction often leaves individuals with dangerous negative effects on their behavior, whether towards themselves or towards others, and this requires the relevant institutions to strive for important and constructive solutions to reform such individuals, and then rid them of their negative behaviors, rehabilitate them and integrate them into society, to become active and effective individuals through their adoption of positive behaviors that are acceptable in line with the values, customs and traditions of their societies to which they belong. Therefore, our current study came to shed light on the most important effects resulting from the phenomenon of drug addiction among individuals through achieving the two research objectives which seek to know: 1- Causes of addiction to drug use among individuals 2- The effect of drug abuse on society. Upon verifying the two research objectives by relying on the analytical method of literature and previous studies, the two researchers reached the following results: First - The most important causes of youth addiction to drugs are poverty, begging, loss of one or both parents, the presence of a criminal in his family, invalid education and other various phenomena and deviations. Second - The symptoms of drug addiction push the addicted person to adopt deviant behaviors, as well as afflicting the addicted individual to psychological and mental pressures, and then afflicting his family with chronic diseases, in addition to the family breakdown occurring in the homes of drug addicts. Key words: drugs; Drug effect; The individual and society.

The Mental Health of Healthcare Staff Working During the COVID-19 Crisis: Their Working Hours as a Boundary Condition.

PurposeHealthcare staff operate at the forefront of the fight against COVID-19 and hence face enormous physical and mental pressures. We aim to investigate healthcare staff’s mental health issues and the associated predictors during the COVID-19 pandemic. Specifically, this paper aims to identify some unique predictors of healthcare staff’s mental health issues in Iran, the second country after China to experience a major COVID-19 crisis.MethodsAn online survey of 280 healthcare staff in all 31 provinces of Iran assessed staff’s mental distress (K6), depression, and anxiety (PHQ-4) during April 5–20, 2020 during the COVID-19 crisis.ResultsNearly a third of healthcare staff surpassed the cutoff for distress, depression, and anxiety symptoms. Females or more educated healthcare staff were more likely to experience distress. Those who were unsure whether they had COVID-19 were more likely to experience distress and depression symptoms. The number of COVID-19 cases among a healthcare worker’s colleagues or friends positively predicted the worker’s anxiety symptoms. Amongst healthcare staff, doctors were less likely than radiology technologists to experience distress and anxiety symptoms. Technicians and obstetrics staff experienced fewer anxiety symptoms. The age and the weekly working days of healthcare staff interacted such that age is asignificant predictor of mental health issues among younger but not older healthcare staff.ConclusionThe identification of the predictors of mental health issues can guide healthcare organizations to screen healthcare workers who are more likely to be mentally vulnerable in the ongoing COVID-19 pandemic.

Utah, Arizona propose bills to add mental health days for students

Legislation proposed in Utah and Arizona would add mental or behavioral health to the list of reasons students can be absent from class, similar to staying out with a physical illness, The Associated Press reported Jan. 30. Similar laws have passed in Oregon, Maine, Colorado and Virginia in the past two years. Offering mental health days can help children and parents communicate and prevent struggling students from falling behind in school or ending up in crisis, said Debbie Plotnick, vice president of state and federal policy at Mental Health America. In Arizona, Democratic Sen. Sean Bowie has introduced a mental health day measure for the second time after legislation stalled in March as the pandemic took hold. Republican Gov. Doug Ducey has taken an interest in youth suicide and mental health, and Bowie said he's confident it will be signed into law. The bill passed the state Senate unanimously Jan. 29. Conservative Utah passed a law in 2018 letting kids take time off school for a mental illness. A new proposal from Republican Rep. Mike Winder would allow absences for students to deal with other kinds of mental pressures to further normalize treating a mental health concern like a physical one.

Psychological Distress Experienced by Women with Primary Infertility in Pakistan: Role of Psycho-Social and Cultural Factors

This study aims to examine the predictive role of psycho-social factors in psychological distress among women with primary infertility and to explore the nature of mental pressures faced by these women. A sample of 200 women with primary infertility was recruited from various infertility clinics in Rawalpindi and Islamabad. A demographic sheet, Urdu versions of General Health Questionnaire, Couple’s Satisfaction Index-4 (CSI-4) a Self-Report Questionnaire (SCQ) were used to assess psychological distress, marital satisfaction, personal and other family members’ desire for child, available social support, and nature of mental pressures faced by women. About 82% of these women reported distress. The standard multiple regression analysis showed that low marital satisfaction (β =-0.716; p<0.001); woman’s non-work status (β =0.183; p<.001) and high personal desire to have child (β =0.136; p=0.006) were significant predictors. Low social support from mother-in-law (β = 0.286; p<0.001) and high personal (β = -0.188; p<.01) and husband’s desire to have child (β = -0.288; p<.001) influenced marital satisfaction. Besides factors such as criticism, loneliness, inquiries made by other people, fear of husband’s second marriage, quarrelsome in-laws were reported as stressors. Women with primary infertility are at increased risk to experience psychological distress attributable to several social and cultural factors.

Between Daedalus and Ariadne

This paper investigates the hidden body in architectural education, and the importance of place over space (Ingold, 2012), through three body, architecture, and movement research projects, where explicitly, at the centre of the architectural investigation, is the body. In the first research project, a mapping of the body in a social environment; in the second, an environmental and spatial audit of the places of drowning across the South West of the UK for the RNLI, reveals the mental and physical pressures that the body can be under; and thirdly, an installation project in the British Pavilion in Venice, which exhibits an experiential journey of mutability between architecture and the body. The position and context of the mythological Ariadne (Colomina, 2011) versus Daedalus (McEwen, 1994) as either architect or choreographer is graduated across the projects set with the ecological context of Guattari’s, ‘Three Ecologies’ (1989)

The Relation between Individual Characteristics and Job Stress in PT. PAL Indonesia

Introduction: Quality Assurance and Quality Control Division workers are challenged by various mental and physical pressures that might trigger job stress. Many factors contribute to job stress, one of them is the individual factor. This study’s purpose was to examine and analyze whether or not there was a relation between the individual characteristic factors and job stress at PT. PAL Indonesia (Quality Assurance and Quality Control Division). Methods: This research was a cross-sectional study. This research had a population of 49 people. The sample was counted using a simple random sampling method and 44 people were obtained as samples. This study’s independent variables were individual characteristics (working period, age, sex, and marital status) and job stress as the dependent variable. Data collection methods for this study were interviews with a questionnaire guide. The data analysis technique used was Fisher's Exact. Results: The result of Fisher Exact statistical test showed that there was not any relation between working period and job stress (p = 0.170), age and job stress (p = 0.456), gender and job stress (p = 0.290), marital status and job stress (p = 1,000). Conclusion: It can be concluded that individual characteristics has no significant relationship with job stress on employees of the Quality Assurance and Quality Control division of PT. PAL Indonesia (Persero). Keywords: individual characteristics, job stress, quality assurance and quality control division

Searching for Street Parking: Effects on Driver Vehicle Control, Workload, Physiology, and Glances.

Urban areas that allow street parking exhibit a heightened crash risk that is often attributed to factors such as reduced road width, decreased visibility, and interruptions to traffic flow. No previous on-road studies have investigated how the demands of searching for parking affect driving performance, physiology, and visual attention allocation. We are interested in these effects on the driver and their possible influence on the safety of the environment. While simulator studies offer several benefits, the physical, mental and social pressures incurred by searching for parking in an urban streetscape cannot be emulated in a simulator. We conducted an on-road instrumented vehicle study with 28 participants driving in downtown Toronto, Canada to explore the effect of searching for street parking on drivers. During the experiment, participants drove two routes in a counterbalanced order: one route with a parking search task, and the other route as a baseline. Speed and lane position were measured via vehicle instrumentation, heart rate and galvanic skin response were measured through physiological sensors, and gaze position was collected through a head-mounted eye-tracker. Participants completed the NASA Task Load Index after each route. It was found that while searching for parking, participants drove slower and closer to the curb, and perceived higher workload. While there were no statistically significant effects in physiological measures, there was a rise in heart rate approaching statistical significance. A detailed analysis of eye-tracking data revealed a clear change in glance behavior while searching for parking, with an increase in long off-road glances (>2 s) and decrease in shorter off-road glances (<1.6 s). Some exhibited behaviors (e.g., slowing down) may be seen to compensate for the potentially negative effects of increased demands associated with parking search, while others (e.g., increase in long off-road glances) have the potential to increase crash risk. This study acts as an important first step in revealing changes in driving performance, physiology and glance behavior brought on by searching for parking in a real-world urban environment.

INFLUENCING FACTORS ON PERFORMANCE OF SOCIAL BEHAVIOR SETTINGS AT PARKS AND GREEN SPACES OF TABRIZ

Parks and green spaces are significant areas that are necessary to reduce citizens’ mental and moral pressures more than ever. So, as for the importance of parks and urban green spaces, consideration of influencing factors on performance of these areas as citizen’s social behavior setting is basically significant. This research seeks to answer the question of how citizens’ behaviors are distinctly the same in terms of gender, age and social and economic characteristics in urban parks. The population of this research is represented by those who go to the parks and green spaces of Tabriz metropolis. The Cochran’s formula was used to select a sample of 400 subjects who were specified by a simple random method. The reliability of the questionnaire was calculated at 0.902 using the Cronbach’s alpha formula while the research data was analyzed via the descriptive-inferential approach. The implementation of factor analysis model reduced the 62 variables of citizens’ social behavior to 23 variables and 4 factors. In considering the effects on citizen’s behavior in parks, these factors in order of preference are: social-psychological, physical-structural, economic and environmental. These four factors can explain 85.272% of the citizen’s social behavior. The stepwise regression test results showed that all the analyzed variables, referring to the performance of citizen’s social behavioral setting in parks and urban green spaces, are positively and meaningfully correlated. The independent t-test results showed that the urban park performances as behavior setting register significant differences between men and women. In this sense, the conclusions of the paper highlight the need to consider the complex needs of the residents in the designing and execution process of urban parks and green spaces.

Spiritual Poverty in Islam (1): Its Harms from the Perspective of the Holy Qur’an and Hadiths

The current era, despite the many advances in communication, technology, scientific and economic development that has taken place in it, not only has not brought security and mental and spiritual peace for human beings; rather, it has added to the mental pressures, worries, anxieties, and inseparable material and worldly attachments. Some people in this period have neglected their origin and have become confused. If a person neglects the spiritual dimension of his existence and forgets the truth of his existence and his originality, he will suffer from spiritual poverty. Spiritual poverty with its harmful damages has many adverse effects on the spiritual life of man and causes anxiety, worry and stress for him and endangers his mental and psychological security. According to the teachings of religion and Islam, the source of all these psychological anomalies and disturbed memories is cutting off from God Almighty and unbelief. Some people spend all their purpose and motivation on physical affairs and they are unaware of their spiritual knowledge and spiritual dimension. This means that if a person does not communicate with his Creator, he will experience turmoil in his life, inner worries and mental illnesses. The present article, using a descriptive-analytical method and relying on Qur’anic and narrative documents, while explaining the concept of spiritual poverty, has analyzed its most important harms. The research findings indicate that the most important harms of spiritual poverty include: feelings of emptiness and depression, aimlessness and meaninglessness, anxiety, despair and hopelessness and torment in the hereafter.

Prediction of Health Risk and Estimation of Associated Variables with Work Stress using Allostatic Load Index

Introduction The terms 'occupational stress', 'work stress', ‘job stress’ and ‘work-related stress’ are known to be interchangeable1. They refer to how persons go through mental and physical pressures to the extent that they may fail to achieve their career goals2. Acc

Moral courage and psychological empowerment among nurses

BackgroundMoral courage is one of the fundamental values of nursing profession and a powerful method of coping with ethical problems. Psychological empowerment is a suitable method of enabling individuals to coping mental pressures of the work environment. This study determined the correlation between moral courage and psychological empowerment of nurses.MethodsThis was a descriptive cross-sectional study. A total of 180 nurses employed in different wards were selected randomly. Data were collected by Demographics Questionnaire, Sekerka’s Moral Courage Scale, and Spreitzer’s psychological empowerment Scale and analyzed with SPSS16 using descriptive and inferential statistics.FindingsThe results indicated that the mean score of moral courage was 21.11 ± 69.90 and the greatest amount of moral courage was in the dimension of “going beyond compliance”. The mean score of “psychological empowerment” was 30.9 ± 73.58 and the greatest mean belonged to “competence”. There was a positive significant correlation between “psychological empowerment” and “moral courage and its dimensions” (P < 0.05).ConclusionThe findings suggested a correlation between moral courage and psychological empowerment. Thus, nurses’ moral courage could be enhanced by reinforcing their psychological empowerment leading to increased patient satisfaction and quality care.