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1. INTRODUCTION
The term commitment is widely used in sociological discussion. The sociologists use it in analyses of various phenomena such as power, political behavior, religion, relationship, and occupational recruitment [3, 17, 23, 36, 37]. In addition, the concept of commitment also enjoys use in studies of occupational careers. In occupational area, the term commitment is also viewed as a major factor which has positive relationship between employees and organizations [14, 17, 20]. For example, the nurses with high level of commitment are more responsible for distributing health care for the patients; they will work with all their capacities to bring the good outcomes for their patients [17]. According to Pender Health Promotion Model, commitment to a plan of action is a strong predictor to implement the health promoting behavior [28]. Commitment motives individual involve into action unless there is a competing demand. Clearly, the person is envisioned as having acting in such a way “made a commitment” or being such a state “being committed”.
In terms of nursing perspective, the more commitment among nurses into healthcare settings, the fewer medical errors and better quality care for patients [38]. Researches have showed that there was a relationship between organizational commitment and job satisfaction among nurses [38, 39]. It is clear that employee satisfaction and commitment are the indicators to the harmony between the team of employees and their management. Job satisfaction can come from the rewards or incentives that the nurses get when they do their job [39, 40]. Therefore, it is important that administrators should realize and enhance trust among nurses, establish a fair and attractive reward system, and increase nurse job satisfaction to elevate their commitment to the healthcare settings.
Despite growing attention, the concept of commitment still remains ambiguous and abstract in nursing area. Little known about the concept of commitment in the literature review, almost studies had done to analyze concept of commitment in terms of occupational careers [14, 17, 23, 25, 37]. Therefore, to integrate commitment more directly into the discipline of nursing, a clearer understanding of the concept is required.
2. METHOD
The concept of commitment was analyzed by using the Walker and Avant [35] methodology, the purposes of the analysis is presented followed by uses of the concept commitment in all areas including dictionary, theory, marriage, sociology, and nursing. After determining the uses of the term commitment, an operational definition of commitment was provided, as well as the critical attributes of the concept is presented. After derived the critical attributes of concept, constructed cases are discussed, followed by the discussion of antecedents and consequences of the concept of commitment. Finally, the empirical referents and implications for nursing knowledge are presented to further elucidate the concept of commitment. A framework representing the concept of commitment is also shown in this paper.
3. RESULTS
To begin with the clarification process, the uses of the term “commitment” were explored. The author searched from electronic databases including Dictionary, PubMed, CINAHL, ScienceDirect, Google scholar and SAGE with the key words such as “commitment”, “commit”, “professional commitment”, “organizational commitment”, and “commitment concept analysis”.
According to Walker and Avant, before undertaking into the concept analysis, this is very important to identify the purposes of concept analysis in order to guide for the process. The first purpose of this concept analysis is to clarify the meaning of commitment, this leads to produce an operational definition of commitment that can be used in nursing research. Moreover, understanding about the commitment concept is also significant for nurses to provide the nursing intervention to promote the health promoting behavior for the patients in term of nursing care [28]. The second aim of this study is to provide the empirical referents to measure the concept of commitment.
The Cambridge Dictionary defines commitment as “a willingness to give your time and energy to something that you believe in, or a promise or firm decision to do something” [9]. Rusbult and Buunkdefined commitment “represents long-term orientation, including feelings of attachment to a partner and desire to maintain a relationship, for better or worse. Commitment as a subjective state, including both cognitive and emotional components, that directly influences a wide range of behaviors in an ongoing relationship” [31]. In addition, commitment in term of marital relationship is viewed as “the strength of an individual’s desire and determination to continue a particular marital relationship” [13].
Porter, Steers, Mowday, and Boulian described commitment as “an attachment to the organization, characterized by an intention to remain in it; an identification with the values and goals of the organization; and awillingness to exert extra effort on its behalf” [29]. Additionally, Caught and Shadur defined commitment is “the employees’ state of being committed to assist in the achievement of the organization’s goals, and involves the employees’ levels of identification, involvement, and loyalty” [11]. By the time, Cohen also defined “commitment as a force that binds an individual to a course of action of relevance to one or more goals” [12]. According to Mowday, Porter, and Steers the term commitment was defined by three components including “(a) a strong belief in and acceptance of the organization’s goals and values; (b) a willingness to exert considerable effort on behalf of the organization; and (c) a strong desire to maintain membership in the organization” [26].
The commitment is also viewed as a strong predictor which can predict for the performance of a health promoting behavior. Commitment initiates a behavioral event. It implies the cognitive process including (1) commitment to carry out a specific action at a given time and place and with specified persons or alone, and (2) identification of definitive strategies for eliciting, carrying out, and reinforcing the behavior [28]. Bergmann, Lester, De Meuse, and Grahn defined commitment in nursing as “loyalty and tendency to remain in the profession and responsibility to the professional issues and challenges” [8]. Jafaragaee and colleagues defined commitment in nursing is “a complex phenomenon comprising intention to stay and work as a nurse; feeling responsibility for the profession; participating in professional workgroups; and tendency to career promotion” [17]. In one study of Garcia-Moyano and colleagues, the concept of commitment in nursing was defined as “the acquisition of knowledge and skills that allow a moral idea to be formed, through values, about the provision of good service of care, acknowledging the autonomy, self-regulation and responsibility inherent to the nursing profession, which creates a feeling of belonging to the profession” [14].
Based on the literature listed above, an operational definition of commitment that commitment can be defined as the act of pledging or promising to fulfill an obligation or an action to someone or something and persistently involve in the obligation or in the action, as well as accept the responsibility when perform the obligation or the action.
The reviewed of the uses on commitment gave some common themes in the author perspective. The author uses these themes to define the critical attributes of the concept. The critical attributes are the characteristics of the concept. From the critical attributes of concept, we can identify the occurrence of the concept [35]. The critical attributes of commitment derived from this analysis are: 1) Promising to involve in an action; 2) Acceptance of responsibility for the action; 3) Persistent involvement in an action.
The attribute of promising to involve in an action derived from the uses in dictionary, sociology, and nursing. While person has the commitment into action, they will accept the responsibility of the action, it is important attribute of concept of commitment, it is derived from very common themes such as “a feeling of responsibility that an employee has towards the mission of the organization”, or “it is sort of responsibility, something that you cannot run away from; something that you have to account for”. The third attribute of commitment has been derived as the persistent involvement in an action. It is derived from common words such as persist, maintaining, remain and continuing. This is obviously sign to see if one person is committed or not. If they committed into an action, the need to have this attribute, maintain or continuing in the action, or in the relationship.
By constructing the cases, the instance of the concept and the instances that are not included in the concept can be identified visually. Therefore, an understanding of what is the concept and what is not will be facilitated [35]. The constructed cases were created as model case, contrary case, borderline case, and related case. For each case, the discussion was also provided by the researcher.
A model case contains all the defining attributes of a concept which were mentioned and it is a case that represents and describes a true example of the concept of commitment:
Ms. Hong is a pregnant woman and this child is her first child. She searched information about feeding methods and she found that breastfeeding exclusively is the best method to feed her baby. She promises herself that she will give exclusive breastfeeding to her baby. She decided that she will give only breast milk for her baby whatever circumstances. She acknowledged that she might not have time to go out until 6 months after birth. After delivery, she started to give breast milk for her baby and continue to breastfeed exclusively during 6 months. After 6-month exclusive breastfeeding, she adds complementary food for her baby parallel with breast milk to ensure her baby having enough nutrition for the development and growth.
In this model case, it has all of the critical attributes of commitment, including promising to involve in an action, which she promised herself that she will give only breast milk for her baby whatever circumstances; acceptance of responsibility for the action which she acknowledged that she might not have time to go out until 6 months after birth; persistent involvement in an action which she continue to give breastfeeding exclusively for her baby during 6 month and after 6-month exclusive breastfeeding, she continue to give breast milk parallel with complementary food.
A contrary case is described as an illustration where it is obvious that it is not the concept:
After graduated from nursing school, Long, 23 years old, took a job in an emergency room. He told his friends that he did not want to become a nurse; he likes to be a singer. The reason to make he studied in nursing because of his parents. His parents want him to easily get a job after graduation so that they convinced him to entrance in nursing school. In fact, Long had little patience in caring for his patients, and he resented the heavy workload nurses must bear. To avoid having to work in hospitals and emergency room, he tried to look for another job. Finally, approximately 2 months after, Long found another job and he left the hospital without notice.
Long’s case is completely an example about the contrary to the model case. He is not interested in nursing profession as his career. The obviously evident that he tried to find another job which he thinks it is more appropriate with him. He did not accept the responsibility to be a nurse such as he had a very little patience to take care for his patients, and he also showed the resentment because of heavy workload nurses must bear. Moreover, Long gave no information or notification before he left the hospital, this is a clear sign that he has lack of persistent involvement in his career. In conclusion, none of attributes of commitment can be found in this case.
A borderline case contains some of the defining attributes of the concept:
Ms. Han has delivered a baby boy; she already has a daughter aged 2 year-old. The first child, she gave formula milk to her baby because she had cesarean section. This time is a boy baby and her family is very happy and she knew all the benefits of exclusive breastfeeding to her child, therefore, she strongly promises that she will give only breast milk to her second child during 6 months. She also knows that she will be very busy to take care for her daughter and give breastfeeding exclusively to her second child. She might not have time to care for her beauty during the time she feed her child. However, she can only give exclusive breastfeeding for her son in the first week after delivery, after that she could not give exclusive breastfeeding to her son because she is extremely busy to take care of her children.
The borderline case has two of the critical attributes of commitment including promising to breastfeeding and acceptance of responsibility in which she knows about the benefits of breastfeeding, promise to give only breast milk to her second child during 6 months and she accepted that she is very busy and might not have time to care for her beauty during the time she feed her child. However, the third attribute of concept is lack, she could not involve in breastfeeding persistently.
A related case does not contain all the defining attributes of the concept; however, it is an example that is closely related to the concept of commitment. In this case, the author made the scenario about the concept of satisfaction on job performance:
Truc, who was a midwife, 26 years old, worked in a delivery unit. She graduated from midwifery-nursing school as an outstanding student. She had good knowledge in her specialty as a midwife. Although Truc showed her enjoyment in working, she had a poor relationship with her colleagues. She rarely gave favors for her colleagues, and she was unwilling to get involved in unit or hospital activities. She said, “I just work here and get paid for what I do. I am not interested in anything in this unit or hospital other than my work”.
In this related case, Truc is satisfied with her work performance. However, she has no interest in anything other than her work such as she rarely help her colleagues and unwilling to join in the activities which were provided by the hospital or her unit. Besides, she has a poor relationship or connection with her colleagues even though she has enjoyment in working as a midwife. Obviously, Truc has only satisfaction with her job, but she has no commitment to her job or her organization.
Determining the antecedents helps us to clarify the meaning of the concept; it also helps to examining the use of concept in social context. The antecedents are also helpful in further refining the defining attributes of the concept. According to Walker and Avant, antecedents are the events that must occur or be in place prior to the occurrence of the concept [35]. Using the reports from previous studies, the personal characteristics such as educational level and age can be the antecedents of commitment [1, 2, 4, 5, 10, 19, 24, 32]. Development of genuine love is the most applicable to the process of commitment. When they have the genuine love, they are more likely to commit in an action or a profession. For instance, one nurse stated that “It is all of my life. Most of time I am here because I feel myself in a position in which I could be useful for a poor patient” [17]. Besides that, the degree of confidence is an antecedent of commitment. In the study of Avery and colleagues, the participants reported that their confidence was varied in the process of breastfeeding and in their ability to breastfeed. The higher level of confidence in the process of giving breast-milk for their babies, the higher level of commitment to making it work and overcome any obstacles among breastfeeding mothers [6].
Information and prior experience are considered as antecedents of commitment. If the person knows information or have previous experience about something which they are going to get involved in the near future, they will have well-preparsed and tend to be committed in that action. For example, mother who had experience with breastfeeding, they tend to be committed to give breastfeeding for the next child [2] or if they know about the information of benefits of breastfeeding via their friends, their parents, husbands, or health care providers, their commitment to give breastfeeding will be occurred when they have children. One of the antecedents of commitment from the literature is empowerment. The empowerment is an important cause of commitment in variety context. In the context of occupation, the employee were empowered, they tend to be committed with their job. Empowerment gave the employee the power of decision making to make the employees own their work and therefore increase the commitment [30, 33].
Consequences are the events that occur as a result of the occurrence of the concept; or in other word, it is the concept’s outcome. Determining the consequences of a concept helps to identify relationships and to guide for further research on the concept [35]. Karrasch stated that commitment caused job promotion and professional growth among people. When people commit in their career, they will have the responsibility to perform their duties as best as they can, and they also persist in this career, as the result, they will perform the higher level of their performance in their jobs and they have potentially getting promotion in their career [21]. Hackett, Bycio, and Hausdorf found that person committed to the organization was positively related to job performance. They have higher level of job performance in their organization [15]. In other words, commitment increases the personal motivation in their professionals from a positive perspective, instead of focusing efforts on the rewards [17]. In addition, nurses with high levels of professional commitment attempt to promote holistic care for patients [14]. As a consequence, in a long term, the nurses with increase their participation and satisfaction in their workplaces and their jobs; as well as they will have higher level of performance in their jobs and workplaces. Similarity, in the study of Bateman and Strasser found that satisfaction is the consequences of commitment [7]. Importantly, commitment will foster creativity and innovation in nursing professional [18, 21].
According to Walker and Avant, empirical referents are “the classes or categories of actual phenomena that by their existence or presence demonstrate the occurrence of the concept itself. It means that you can recognize or measure the defining attributes of the concept” [35]. In order to measure effectively the degree of commitment, a combination of quantitative and qualitative methods is required. The methods can be used to measure the concept of commitment including self-reported, or observation, or in-depth interview. For examples, to measure the commitment in breastfeeding of mothers, indications of commitment in breastfeeding in those reports from mothers would be statements like “I arrange my life so that breast milk is almost the only thing my baby gets;” “I became more relaxed as I sat and breastfed;” “ I feel breastfeeding is providing my baby with an ideal food;” “I was satisfied with breastfeeding”. In addition, quantitative instruments have received widely used to measure the breastfeeding commitment of mothers including H & H Lactation Scale developed by Hill and Humenick [16].
There are some instruments from the literature were used to measure the concept commitment in term of organizational, relationship, and professional which were developed by Rusbult, Martz, and Agnew namely the Investment Model Scale including 15 items with 9-point Likert scale ranged from do not agree at all (0 score) to agree completely (8 scores) measuring the level of commitment in the relationship with three subscales: intent to persist, attachment, and long-term orientation [31]. In addition, commitment was also measured by the Commitment Inventory which was developed by Stanley and Markman with 36 items measuring the level of commitment, the high scores reflecting higher level of dedication commitment. All items were measured on 7-point Likert scale which ranged from 1 point for strongly disagree to 7 points for strongly agree [34]. Another scale to measure the commitment is the Organizational Commitment Questionnaire consists of 15 items measures three aspects of organizational commitment including affective commitment, normative commitment, and continuance commitment [27].
4. CONCLUSION
The process of analysis concept of commitment leads to a better understanding of the concept itself. It provides some benefits to nursing perspectives. Nurses can use the ideas of this analysis as conceptual tools to assess the level of commitment among patients/clients in their action toward the health promoting behavior such as commitment in dietary for diabetes patients, or commitment to do exercise among hypertension patients, or commitment to give exclusive breastfeeding for infants after delivery. Understanding concept of commitment, nurses can then understand the stages of behavior among their patient/clients so that the strategies or interventions could be proposed to increase the commitment among patients in the health behavior. In addition, by awareness about the developmental stages of commitment, nurse can identify where their patients/clients are in the stage of the evolution of commitment and guide those people to achieve a desired next stage.
