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CHAPTER - III

RESEARCH METHODOLOGY

3.1 Research methodology

With reference to the objectives set for the study detailed methodology is
designed for the study. This methodology determines the frame work with in which the
entire research study was undertaken. This chapter contains detailed about all
methodological aspects which highlight the crucial elements to provide the perspectives
and the backdrop needed to understand the components.

3.2 Research gaps

An exotic study of literature on work life of balance reveal that such a study
focused only on certain aspects of WLB and not a comprehensive treatment of WLB.
For instance in many Indian studies on WLB biographical characteristics of nurses were
not studied (Fisher-McAuley, G., Stanton, J., Jolton, J., & Gavin, J. (2003)[136]).
Similarly composition of different dimensions ( Professional satisfactionsuch as a
Nurses station, Canteen facilities, Cleanliness of the hospital, Physiotherapy/X-ray/Scan,
an attached Pharmacy, a well- equipped operation theatre, updates of latest medical
trends, Lays down strategies to improve your skills, Working long day/evening/Night
and Personal satisfaction such as Overall satisfaction on nursing profession & personal
life, Maintaining good communication with colleagues, Self respect by others, Job
outcome fulfill my satisfactory level, Fringe benefits, Work recognized Personal by
others, Organization will be successful in the employees have a good balance of work
and life, Decision making regarding Profession, I am able to pursue a course of study or
training, inability of balance the amount of Work load, Happy with my job, Childcare
responsibilities, To pursue hobbies, Living ideal/best life) of WLB of nurses and their
relationship among them were not focused. Passion towards nursing profession, life
style choices, work logistics were not studied (Rajesh K. Yadav, Nishant Dabhade
(2013), Kalpana Devi U.V.Kiran, (July 2014) [104], Vlems, 2005) [179] further
professional pride of nurses in private hospitals, was not part of any study. These
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literature gaps warranted an exhaustive study addressing these gaps apart from other
aspects of WLB.

3.3 Justification for the study

The research gap listed above bring to light the need for an in-depth study,
WLB of nurses in private hospitals. WLB refers to how nurses hiring hospitals manage
their domestic life and professional life in such a way that at no point of time the
patients welfare is at risk further a commitment and devotion to nursing would be
present only when the nurses are free from major domestic challenges in addition to
exacting professional demand. While patient satisfaction is important, nurses status of
mind is more important. But often the nurses are exposed to different challenges at their
domestic and professional end causing enormous stress affecting their psychological
and physiological conditions. The reflection of this bound to influence the quality of
services rendered by them and also the patients. Unlike other types services, nursing
service is proved to be a major factor for early patient recovery. If nurses are not
supported to achieve WLB any hospital would encounter poor quality nursing service
and decline in patient inflow. That is absence of support to nurses to achieve WLB in
any hospital, would only recoil on the hospitals concerned. Such hospitals would also
become financially weak and ultimately affecting their stability. In other words mere
provision of WLB supports is not adequate but a periodical review of status of WLB
among nurses would turn out to be a condition for survival. Therefore intensive studies
on WLB need to be undertaken at a different points of time in different private hospitals,
so that appropriate corrective and preventive steps could be initiated to maintain a
healthy WLB among nurses. The current research study is one such initiative by
incorporating all the dimensions of WLB.

3.4 Research questions

In the context of the research gap, a number of questions emerged warranting a

comprehensive research on WLB. Such a research need to address all factors affecting
WLB apart from highlighting the constituents of dimensions of a strong WLB model.
For this purpose this study addressed the following research questions.
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1. What are the different dimensions of work life balance that impact performance
of female nurses consisting of Registered Nurses (RN) and Enrolled Nurses
(EN)?

2. How demographic and biographic factors impact work life balance of female
nurses?

3. What are the variables of dimensions that compose WLB?

4. How these dimensions interact to impact WLB and what is the strength of these
relationships?

5. What is the appropriate approach which hospital administrators have to work

with to increase WLB of nurses?

3.5 Objectives of the study

1. To examine demographic and biographic characteristics of nurses.

2. To identify the attitude towards different contextual variables such as activities
at home, biological hazards, committing errors, impact of overtime, fatigue,
empathy towards self and patients that impact nursing staff.
3. To analyze the work environment and an organismic supports that impact on
attitude towards WLB among the nurses.
4. To identify the determinants of professional and personal satisfaction.
5. To identify the presence of different groups of nurses based on the professional
pride.
6. To determine the appropriate HR intervention policies supporting WLB in
tertiary hospitals.

3.6 Scope of study

1. The study is confined to 15 tertiary hospitals in Chennai metropolitan cities.

2. The study includes specifically Registered nurses and Enrolled nurses who
alone could be recruited by corporate hospitals as per nursing act 1992.
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3.7 Justification for selecting hospitals

Among the city hospitals existing in 2011-2012, hospitals with minimum of 20

beds were identified. These hospitals were selected. Totally the following 15 hospitals
were selected with a bed range of 20 and above 100.

1. A.G. Hospital

2. Apollo Hospital

3. Apollo Hospital (Greams Road)

4. Balaji Hospital

5. Deepam Hospital (P) Ltd.

6. Devaki Hospital

7. Frontier Lifeline Pvt.Ltd.

8. Hindu Mission Hospital

9. Kalyani General Hospital

10. Malar Hospital

11. Philips Hospital

12. City Tower Hospital

13. Sundaram Medical Foundation

14. Vijaya Hospital

15. Chettinadu Health city

3.8 Justification for selecting the specialty from which the respondent nurses
were selected

As per the provisions of Medical Council of India which governs the licensing
of hospitals, any private hospitals would be approved only if 5 specialties are provided.
These five specialties are Intensive Care Unit (ICU), Out Patient (OT), Pediatric,
Psychiatric and Maternity. On this basis this study also was undertaken among the
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nurses working in these five specialties. Only those nurses who were working during
the period of survey where included.

3.9 Sources of data

This study made use of both primary and secondary data. Primary data was
collected from the nursing staff in selected specialties in hospitals selected. The tool
used for collecting primary data was questionnaire and focused group interview for the
purpose of collecting WLB programme related details in the hospitals. Structured
questionnaire was designed and pre-tested with about 40 nursing staff. Based on this
the final questionnaire was developed.

Secondary data

Secondary data have collected from research journals, periodicals reports

including commission reports, government publications, Medical Council of India
website, Nursing Council of India website and other related websites like that of WHO
(World Healthcare organisation), NHO (National Healthcare Organisaon) and others.

3.10 Period of study

Primary data was collected through a sample survey between may 2012 -
august 2013. Secondary data was collected from 1953 to 2013.

3.11 Sampling frame work

As primary data was to be collected through a sample survey among nurses,

data on the different categories of nurses, the classification as given by Nursing Act of
1992 was considered. As per this act there are 5 categories of nurses as given below.

1. Registered nurse (RN)

2. Midwife

3. Enrolled nurse (EN)

4. Nurse practitioner (NP)

5. Unlicensed health care workers (HCWs)

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Registered nurse (RN)

An RN is a person with appropriate educational preparation and competence

for practice, who is licensed.

Midwife

A midwife is a person with appropriate educational preparation and

competence for practice, who is licensed.

Enrolled nurse (EN)

An EN is a person with appropriate educational preparation and competence

for practice, who is enrolled and licensed.

Nurse practitioner (NP)

An NP is educated to function autonomously and collaboratively in an

advanced and expanded clinical nursing role. The role includes assessment and
management of clients and may also includes, the direct referral of clients to other
health care professionals, Prescribing medications and Ordering diagnostic
investigations.

Unlicensed health care workers (HCWs)

There are a number of unlicensed workers within the health care system that
work in conjunction with licensed practitioners

3.12 Sample size determination

The total number of RN and EN in the 15 selected hospitals was 606. And
these nurses were on roll during the period of survey. The size of sample was selected
using Cochran’s formula.

Sample Size (n) = (1.96)² (.5)² (.5)²/(0.05)² = 384.

In order to improve the reliability of sample data, more than 900 questionnaire
were distributed, of which only 606 completely responded questionnaires were
separated. Therefore the sample size was raised to 606.
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Table 3.2 The distribution of sample respondents among the selected hospitals is
presented below.

Total Number of
S.
Hospital Name Number of Samples Percentage
No
Nurses Selected

1. A.G. Hospital 86 28 33

2. Apollo Hospital 171 91 53

3. Apollo Hospital (Greams 132 87 66

Road)

4. Balaji Hospital 37 18 49

5. Deepam Hospital (P) Ltd. 43 21 49

6. Devaki Hospital 29 22 76

7. Frontier Lifeline Pvt.Ltd. 61 41 67

8. Hindu Mission Hospital 52 29 56

9. Kalyani General Hospital 48 24 50

10. Malar Hospital 36 19 53

11. Philips Hospital 44 21 48

12. City Tower Hospital 59 40 68

13. Sundaram Medical Found 78 44 56

ation

14. Vijaya Hospital 131 84 64

15. Chettinadu Health city 78 37 47

Total 1085 606 100

From the above table it would be clear that about 56% of RN & EN working in
the 15 selected hospitals constituted the sample size. Care was taken that at least 30% of
the total number of RN & EN working in the selected hospitals are included as
respondents.
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3.13 Null Hypothesis set for the study:

Based on the objectives determined for the study variables were identified and
these variables formed the basis for developing 49 null hypotheses. These null
hypotheses are presented below.

Null Hypothesis

(H1) : There is no significant association between age and overall satisfaction

(H2) : There is no significant association between qualification and overall satisfaction

(H3) : There is no significant association between marital status and overall satisfaction

(H4) : There is no significant association between salary and overall satisfaction

(H5) : There is no significant association between professional experience and overall

satisfaction

(H6) :There is no significant association between number of years of experience as a

nurse and overall satisfaction

(H7) : There is no significant association between department and overall satisfaction

(H8) : There is no significant association between number of beds in the hospital and
overall satisfaction

(H9) : There is no significant association between nursing specialty and overall

satisfaction

(H10): There is no significant difference between overall satisfaction and life

satisfaction on work life balance of female nurses in urban hospitals.

(H11): There is no impact or influence between flexible time arrangement, socialization

and work life balance of female nurses in urban hospitals, Chennai District.
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(H12): There is no impact or influence between women supportive measures and work
life balance of female nurses in urban hospitals, Chennai District.

(H13): There is no impact or influence between provision of perks relating to food and
work life balance of female nurses in urban hospitals, Chennai District.

(H14): There is no impact or influence between insurance, pension plan, financial

services and work life balance of female nurses in urban hospitals, Chennai District.

(H15) : There is no significant difference between unhelpful attitude of family members

or relations and attitude towards career

(H16) : There is no significant difference between unhelpful attitude of family members

or relations and unhelpful attitude of superiors

(H17) : There is no significant difference between unhelpful attitude of family members

or relations and unhelpful attitude of colleagues

(H18) :There is no significant difference between unhelpful attitude of family members

or relations and children have a disability or special need

(H19) :There is no significant difference between attitude towards career and work life
balance programme

(H20) :There is no significant difference between attitude towards career and unhelpful
attitude of superiors

(H21) :There is no significant difference between attitude towards career and unhelpful
attitude of colleagues

(H22) :There is no significant difference between attitude towards career and unhelpful
attitude of family members or relations

(H23) :There is no significant difference between children have a disability or special

need and work life balance programme
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(H24) :There is no significant difference between work life balance programme and
unhelpful attitude of superiors

(H25) :There is no significant difference between work life balance programme and
unhelpful attitude of colleagues

(H26) :There is no significant difference between work life balance programme and
unhelpful attitude of family members or relations

(H27) :There is no significant difference between unhelpful attitude of superiors and

unhelpful attitude of colleagues

(H28) :There is no significant difference between unhelpful attitude of superiors and

unhelpful attitude of family members or relations

(H29) :There is no significant difference between unhelpful attitude of colleagues and

children have a disability or special need

(H30): There is no significant relationship between continue in the same position and
switch to a less demanding role in nursing

(H31): There is no significant relationship between continue in the same position and
work as a travel nurse

(H32): There is no significant relationship between continue in the same position and
switch to part-time

(H33): There is no significant relationship between continue in the same position and
seek a job or business in a non-nursing field

(H34): There is no significant relationship between continue in the same position and
pursue higher studies

(H35): There is no significant relationship between continue in the same position and
pursue higher studies
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(H36): There is no significant relationship between switch to a less demanding role in

nursing and work as a travel nurse

(H37): There is no significant relationship between switch to a less demanding role in

nursing and switch to part-time

(H38): There is no significant relationship between switch to a less demanding role in

nursing and seek a job or business in a non-nursing field

(H39): There is no significant relationship between switch to a less demanding role in

nursing and pursue higher studies

(H40): There is no significant relationship between switch to a less demanding role in

nursing and retire

(H41): There is no significant relationship between work as a travel nurse and switch to
part-time

(H42): There is no significant relationship between works as a travel nurse and seek a
job or business in a non-nursing field

(H43): There is no significant relationship between works as a travel nurse and pursue
higher studies

(H44): There is no significant relationship between works as a travel nurse and retire

(H45): There is no significant relationship between switch to part-time and seek a job or
business in a non-nursing field

(H46): There is no significant relationship between switch to part-time and pursue

higher studies

(H47): There is no significant relationship between switch to part-time and retire

(H48): There is no significant relationship between seek a job or business in a

non-nursing field and pursue higher studies
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(H49): There is no significant relationship between seek a job or business in a

non-nursing field and retire

(H50): There is no significant relationship between pursue higher studies and retire

Table 3.3 Tools of analyses :

Sl.No. Objective Tools used Justification

1 Objective 1: Chron-bach To determine the

Alpha reliability of
To examine a demographic and
questions listed in
biographic characteristic of
the questionnaire
nurses.
and also to examine
the internal
consistency.

This was applied to

Frequency examine the
analysis demographic and
biographic
characteristics of the
selected respondents
and also to analyze
the mean weight of
the scaled responses.

2 Objective 2: Chi -square An association

between different
To identify the attitude towards
variables had to be
different contextual variables such as
tested, this test was
activities at home, biological hazards,
used.
committing errors, impact of
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Sl.No. Objective Tools used Justification

overtime, fatigue, empathy towards

self and patients that impact nursing
staff.

3 Objective 2: Paired sample As there was a

t-Test necessity to test
To identify the attitude towards
hypothesis to
different contextual variables such as
regarding the factors
activities at home, biological hazards,
which hinder related
committing errors, impact of
career progress
overtime, fatigue, empathy towards
paired sample t-test
self and patients that impact nursing
was applied.
staff.

Objective 3:

To analyse the work environment and

an organisationl supports that impact
on attitude towards WLB among the
nurses.

4 Objective 2: Discriminant This tool was

Analysis applied to identify
To identify the attitude towards
the demographics
different contextual variables such as
characteristic which
activities at home, biological hazards,
is significant in
committing errors, impact of
affecting the passion
overtime, fatigue, empathy towards
towards profession.
self and patients that impact nursing
staff.
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Sl.No. Objective Tools used Justification

Objective 3:

To analyse the work environment and

an organisationl supports that impact
on attitude towards WLB among the
nurses.

5 Objective 2: Spearman’s To test null

Rank hypothesis relating
To identify the attitude towards
correlation to various options of
different contextual variables such as
future plans.
activities at home, biological hazards,
committing errors, impact of
overtime, fatigue, empathy towards
self and patients that impact nursing
staff.

Objective 3:

To analyse the work environment and

an organisationl supports that impact
on attitude towards WLB among the
nurses.

6 Objective 2: Factor To identify the

To identify the attitude towards Analysis important factors

different contextual variables such as affecting WLB.

activities at home, biological hazards,

committing errors, impact of
overtime, fatigue, empathy towards
self and patients that impact nursing
staff.

Objective 3:
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Sl.No. Objective Tools used Justification

To analyse the work environment and

an organisationl supports that impact
on attitude towards WLB among the
nurses.

7 Objective 4 Multiple To identify the

To identify the determinantsof Regression various WLB factors

professional and personal satisfaction Analysis which determine

professional
satisfaction of
Nurses.

8 Objective 4 Structural To examine causal

To identify the determinantsof Equations relationship among

professional and personal satisfaction model the variables which

influence personal
satisfaction and
professional
satisfaction.

9 Objective 5 Cluster To identify the

To identify the presence of different Analysis groups of

groups of nurses based on the individuals or object

professional pride on their to classify the

professional pride. respondents into

homogeneous sub
groups.

10 Objective 6 Factor To identify the

To determine the appropriate HR Analysis important factors

intervention policies supporting WLB affecting WLB.

in tertiary hospitals.
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3.14 Limitation of the study

z The presetaken into considerationnt study has the needs of nursing staff
working in tertiary hospitals and may not be applicable to all nursing staff.
z This study is contextualized for hospital industry and may not be generalized to
other professions.
z The study has focused on the work life balance of nurses in Chennai. Basically
the environmental factors play dynamic role in the organizational settings which
affect the work life balance of nurses in Chennai. The strength of work
environment factors brings work life balance for the nursing staff. Based on the
literature review it was found that there were number of variables associated
with this topic. To bring the best outcome for the study, this study has focused
upon limited number of independent variables that are essential to make
appropriate inferences. Secondly, the study focused only on the variables
which are connected with work environment and work life balance aspects, in
other words, the study has not concentrated on coping strategies and elaboration
of coping strategies handled by nurses is one of the important factors that may
be studied in future.

3.15 Indications for future research

1. Similar type of study could be undertaken in hospitals in other corporate

hospitals as well as major cities in Tamilnadu.

2. A comparative study of this type would bring to light the different levels of
work life balance in different locations.

3. Nurses of all categories may also be included to identify the WLB and the
professional stress.