الفهرس 
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Abstract
OCB is vital for the development of the healthcare organization, and this is highly required in hospitals because healthcare personnel must work as a team and work by innovative workers, also nurse managers must adopt OCB to improve healthcare organizational image and employee brand. Lacking OCB affects OE, and organizational image in today’s highly competitive business.
Aim of the study:
This study aims to identify the effect of implementing training program on organizational citizenship behavior model for nurse managers on organizational effectiveness
Setting:
This study was conducted at Mabert El Asafra East Hospital. All its departments were included in the study (n=13) namely (general ICU A, ICU B, ICU C, isolated ICU, post cardiac catheterization, NICU, kidney dialysis, emergency department, operation department, and words departments at the fifth, sixth, eighth, and tenth floor). It is affiliated to non- governmental health organizations in the Alexandria Governorate. Mabert El Asafra East hospital was selected because it provides wide range of services for multi-specialty (as medical, surgical, pediatric, obstetric, critical care, kidney dialysis, and outpatient services) and had a bed capacity of more than 50 beds and had a large number of nurse managers and acceptance of the hospital administrator to conduct the study proposal. Recently, it is also undergoing the process of national hospitals accreditation by Ministry of Health and Population.
Subjects:
The target population for this study included two groups; group (1) included nurse managers who were working in Mabert El Asafra East hospital in different managerial positions who worked in different settings (n=23) as presented in table (1).
group (2) included a proportion sample from all nurses who were subordinate to the selected nurse managers (N=253) to assess their perception of OE before, immediately after, and two months after nurse managers attended the OCB training program.
- The appropriate sample size of nurses is (n=91), which was calculated by using Epi- The info program which presented in table (2) which shows the proportion of sample from each unit was determined
- Theconfidence level= 95%,
- Marginal error= 5%.
- The accessible population is identified based on the following inclusion criteria (a) has completed at least six months of experience in the study hospital (b) willing to participate in the study
Tools:
Three tools were used in this study as follows:
Tool (1):Nurse manager’s knowledge about organizational citizenship behavior questionnaire.
This toolwas developed by the researcher to assess the level of nurse managers’ knowledge about OCB. It included 15 closed-ended questions. Each correct answer was given a score of one and the wrong answer was given a score of zero. The scores of the items were summed - up and converted into percentages scores and were classified as follows:
• Less than 50% = poor level of knowledge
• 50- less than 75% =fair level of knowledge
• 75% and more than 75% = good level of knowledge
Tool (2):Nurse managers practice of organizational citizenship behavior observational scale.
It was developed by the researcher to observe the nurse manager’s practice of citizenship behavior. The scoring system was measured by three Likert scales, where (2) = done, (1) partially done, and (0) = not done.It consists of 23 items classified into five dimensions namely:namely Altruism (4 items), Conscientiousness (6 items), Sportsmanship (5 items), Courtesy(4 items), and Civic Virtue(4 items). The scores of the items were summed - up and converted into percentages scores and were classified as follows:
• Less than 50% = poor level of practice
• 50- less than 75% =fair level of practice
• 75% and more than 75% = good level ofpractice
Tool (3):Subordinate nurse’s perception aboutorganizational effectiveness scale (OES)
It was developed by the researcher to assess the level of nurse perception about OE. It consists of 45 items classified into six dimensions namely: human relations (11 items), internal process (10 items), open system
(7 items), competition (6 items), stakeholder (5 items), and job satisfaction
(6 items). The responses were measured on a 5-point Likert scale. The responses were measured on a 5-point Likert scale ranging from (1) strongly disagree and (5) strongly agree.The scores of the items were summed - up and converted into percentages scores and were classified as follows:
• Less than 50% = poor level of perception.
• 50- less than 75% =fair level of perception
• 75% and more than 75% = good level of perception.
In addition, a demographic data sheet was attached to each tool. It was developed by the researcher; it included items related to gender, age, Marital status, educational qualification, working unit, currentJob position, Years of experience in the nursing profession, Years of experience in the current job position, and nurse manager’s years of experience and attendance of any training program about OCB.
Method
1. Official permission was obtained from the Research Ethics Committee at the Faculty of Nursing, Alexandria University to conduct the study.
2. Permission for conducting the study was obtained from the Dean of Faculty of Nursing, Alexandria University, and the hospital administrator to collect the necessary data.
3. Tools (1,2,3) were translated into Arabic and tested for their content validity by a panel of five experts in the field of the study. They were (three professors and two assistant professors of the nursing administration department, at Alexandria University). The necessary modifications were done based on their comments on the translation
4. Tools 2: nurse managers’ practice of OCB observational scale and tool 3: subordinate nurse’s perception about OE scale) were tested for reliability. The internal consistency reliability was assessed using Cronbach’s alpha coefficient. The reliability of tool (2) nurse managers’ practice of OCB observational scale was =0.906; tool (3) subordinate nurse’s perception about OE scale was = 0.965. This proved that the two tools were highly reliable.
5. A pilot study was carried out on 43.4 % of nurse managers (n=10) because when carried out on 10% (n=3) gave error and did not gave result and the pilot study included in the subject , and regarding to staff nurses, the pilot study carried out on (10%) (n=9) from the study settings and it was excluded from target subject; in order to check and ensure the clarity of tools, applicability, feasibility, and to identify obstacles and problems and no any modifications were done.
6. The training program was developed, implemented, and evaluated according to the following phases.
Phase 1: Assessment phase
- Data were collected after obtaining an official agreement from the director of the Mabert El-Asafra East hospital to explain the objectives of the study and to gain his cooperation.
- Assessment was carried out by the researcher to collect data about nurse managers and nurses by the following approach:
a) The researcher used educational needs questionnaire and distributed it to nurse managers to collect data related to their previous training and their desires for an OCB training program.
b) Tool 1: nurse managers’ knowledge about OCB questionnaire used by the researcher to assess the level of nurse managers’ knowledge of OCB before the training program by hand-delivered the questionnaire to their working units and returning it back to the researchers.
c) Tool 2: nurse manager’s practice of OCB observational scale used by the researcher to observe the nurse manager’s practice of OCB. Each nurse manager was observed 2 observations for two shifts, every shift took two hours and relieve for one hour then repeated. and was observed during her/his shift morning or evening or night.
d) Tool 3: Subordinate nurse’s perception about OE scale used by the researcher to assess the subordinate nurse’s perception of OE before introduced the OCB training program for nurse managers. Answering the questionnaire took approximately 15-20 minutes to be completed by each nurse.
e) Data collection of phase 1 took place from 5 April to 28 April 2022.
Phase 2: Planning stage:
a) OCB training program was organized, as follows: the objectives and content were established, and the design of the handout was based on the analysis of data obtained from nurse managers and based on the review of related literature as well as the teaching sessions, teaching strategies, teaching aids, and time schedules were developed.
b) The program included: general and specific objectives, relevant content, educational methods, and teaching strategies such as interactive lectures, discussions, and brainstorming as well as pictures and videos.
Phase 3: Implementation stage:
a) Before the conduction of the training program for nurse managers (director, assistant director, supervisor, and first-line nurse managers) permission was obtained from the hospital managers and nursing service director.
b) For the implementation of the training program, nurse managers were divided into 4 groups; each group attained the training program involved approximately 4-7 nurse managers. Each group attended three consecutive sessions each session two hour to cover the content. The following educational methods were utilized: discussion, and brainstorming as well as PowerPoint, pictures, and videos. The time of program was twenty-two working days between morning, evening, and night shifts. The program encompassed: objectives, content, teaching strategies, and evaluation techniques pre-and post-test. The training program was conducted from 30 April to 26 May.
Phase 4: Evaluation stage:
Training program was evaluated. First, before the beginning of the program. Second, immediately after the program, and finally, two months after the program conduction in order to validate the effect of implementing the training program.
- The researcher used Participants’ reaction questionnaire and distributed it on nurse managers immediately after program implementation to reveal their reactions to the benefit gained from the program. The questionnaire explained how to be answered. Nurse managers were given enough time to answer the questions. Answering each questionnaire took approximately from 10-15 minutes to be completed by nurse managers.
- Knowledge assessment after the training program using post-test tool 1: nurse managers’ knowledge about OCB questionnaire was distributed again to nurse managers immediately after the program and after two months to evaluate the gained knowledge in comparison with the pre-test (15 minutes).
- Observation for nurse managers was conducted by the researcher using tool 2:nurse manager’s practice of OCB observational scale immediately after the program and after two months from the implementation of the training program to assess changes in the performance of nurse managers.
- Evaluation of subordinate nurse’s perception of OE was done immediately after the training program and after two months from the implementation of the training program by using tool 3: Subordinate nurse’s perception about OE scale to collect data related to the effect of the training program about OCB for nurse managers on the OE as perceived by nurses Answering each questionnaire took approximately 15-20 minutes to be completed by each nurse.
- Data collection of the reassessment phase, immediately after the training program from 27 May to 10 June.
- Data collection of the follow-up phase, after two months of the implementation training program, this phase took place from 10 August to 3 September.
The following were the main results of the present study: -
- According to nursing sociodemographic characteristicsfor nurse managers, more than one-third of the studied nurse managers (39.1%) were in the age group ranged from 40 to less than 50 years old. In relation to gender, the study revealed that 73.9% were female.
- According to nursing sociodemographic characteristicsfor studied nurses, 46.2% of the studied nurses ranged from 20 to less than 30 years old. In relation to gender, the study reveals that 62.6% of the studied nurses were female.
- There was statistical significance different between nurse managers’, knowledge levels about OCB before, immediately after and two months after of implementing the training program.
- The highest mean percentage of the studied nurse managers practices on OCB was 84.12 ± 3.56 for immediately after implemented training program compared to 57.56 ± 10.85 before implementing a training program.
- The highest mean percentage of the studied nurses’ related to perception of OE 75.59 ± 11.60 were immediately after implemented training program compared to 47.23 ± 13.86 before the program training implementation.
- Finally, implementing a training program on the OCB model has a significant impact on healthcare OE.