1. WORK ENVIRONMENT, SLEEP QUALITY, CONFIDENCE IN DECISION-MAKING AND EMOTIONAL LABOR OF NURSES MEDIATED BY SELF-EFFICACY
John Patrick Flores
Dina D. Galang
Jezamine De Leon
Susy A. Jael
Myrtle C. Orbon

2. Nurses comprise the largest groups of professionals within the healthcare system. They care for patients continuously, 24 hours a day, to help patients do what they are not able to do for themselves
The dynamic and uncertain nature of the health care environment requires nurses to be competent and confident decision-makers in order to respond to the clients’ needs (Standing, 2014).

3. All throughout the shifts, nurses gather, filter, interpret and transfer data into meaningful information required to diagnose, treat, and make decisions about the care of individual patients (McCauley, 2005).

4. On the discharge of their duties and responsibilities, they are sometimes nagged with numerous complaints from their colleagues, doctors, patients, patients' significant others, superiors, and work environment resulting to engagement in emotional labor ( Brown, 2011; Humprey, 2008).

5. As they perform their responsibilities they too are expected to be compassionate and empathic on top of the challenges from their colleagues, superior and work environment in general.

6. Though there is mounting evidence that work environment, sleep quality, and self-efficacy influence confidence in decision-making and emotional labor, there is a dearth of study on the relationship of work environment, sleep quality, confidence in decision-making and emotional labor as mediated by self-efficacy, thus this study.

7. Research Paradigm Confidence in Decision-Making Sleep Quality
Work Environment
Interpersonal Relationship
Organizational Support
Working Condition
Confidence in Decision-Making
SELF-EFFICACY
Emotional Labor
Surface Acting
Deep Acting
Sleep Quality
Research Paradigm

8. This descriptive correlational study studied 250 staff nurses selected through purposive sampling from eight private hospitals in the province of Laguna.
Registered nurses ages who had worked in the general wards for six months and above; irrespective of their work status, gender, shift, and marital status were included in the study.

9. OVERALL WORK ENVIRONMENT
No.
Item M SD SR VI 1
Interpersonal Relationship
3.83
0.52
Often
Good 2
Organizational Support
4.33
0.61 3
Working Conditions
3.68
0.54
OVERALL MEAN
3.94
0.39
Note: Very Good= ; Good= ; Average= ; Poor= ; Very Poor=

10. The grand mean of 3.94 (SD=0.39), indicates that the grand scale response is often and verbally interpreted as good.
This result implies that the respondents have a positive work environment wherein they reap social, health, and personal benefits from a positive atmosphere at their place of employment.

11. SLEEP QUALITY OF THE RESPONDENTS
No.
Item
Mean SD SR VI 1
Upon waking up I feel: Alert
2.03
0.54
Slightly Agree
Fair 2
Refreshed
2.02
0.58 3
Energized
2.04
0.55 4
Contented with my night’s sleep
1.81
0.62 5
Relaxed
2.00
0.60
OVERALL MEAN
1.98
0.47
Note: Good= ; Fair= ; Poor=

12. Number of sleeping hours of nurses
No. of hours of sleep
Frequency
Percent
Valid Percent
Cumulative Percent 4 16
6.4 5 34
13.6
20.0 6
106
42.4
62.4 7 47
18.8
81.2 8 39
15.6
96.8 9 2
0.8
97.6 10
2.4
100
Total
250
Grand Mean: 6.35
SD: 1.24
To further support the sleep quality of nurses

13. The grand mean of the result is 1. 98 (SD=0
The grand mean of the result is 1.98 (SD=0.47) which has a grand scale response of slightly agree and verbally interpreted as fair.
The result implies that the respondents’ quality of sleep was fair which means that they are not having enough amount of sleep.

14. LEVEL OF SELF-EFFICACY
No.
Item M SD SR VI 1
I believe that I can finish a task completely
4.34
0.73
Often
High 2
I am willing to accept the emotional challenges in my work environment. 3
I can easily recover from the setbacks in my work environment.
4.16
0.76 4
I see to it that I put value to my commitment in my work environment.
4.45
0.69 5
I set goals that are higher than my previous achievements.
4.40
0.72 6
I believe that everything I do in my work environment produces good outcomes.
4.42
0.67 *7
I feel that I am not a competent staff nurse in the work environment
3.64
1.28
Sometimes
Average *8
I cannot multitask.
3.96
1.17
OVERALL MEAN
4.21
0.57
Note: Very High= ; High= ; Average= ; Low= ; Very Low=
*RECODED

15. LEVEL OF CONFIDENCE IN DECISION-MAKING
No.
Item M SD SR VI 1
I identify factors which are important when deciding what intervention to do.
4.23
0.74
Often
High 2
I know how to:
motivate myself to continue getting information
4.28
0.72
b. think alternatives until I come up with a good choice
0.77 3
I shut out distractions so I can concentrate on deciding on one goal.
4.02
0.85 4
I recognize my own anxiety and calm myself before deciding to avoid making poor choices.
4.13
0.75 5
I anticipate important decisions so that I can have needed information and be prepared when the time comes for deciding.
4.19 6
I know who can and cannot give information or counsel that is helpful.
4.07
0.82 7
I estimate the amount of each satisfaction of my alternate choices.
3.98
0.79 8
I estimate the amount of time each of my options will require. 9
I find out the important facts about an action before making a decision.
4.17
0.78 10
I estimate whether I have the ability /energy to accomplish that certain choice.
4.15

16. LEVEL OF CONFIDENCE IN DECISION-MAKING (continued)
No.
Item M SD SR VI 11
I diagnose current problems by looking at past decisions that did not work so that I can improve my decision-making.
4.17
0.78
Often
High
OVERALL MEAN
4.13
0.62
Note: Very High= ; High= ; Average= ; Low= ; Very Low=

17. The grand mean score of the confidence in decision-making of nurses is 4.13 (SD=0.62).
Its grand scale response is often and verbally interpreted as high.
It implies that nurses in Laguna have a high level of confidence in terms of decision-making.

18. EMOTIONAL LABOR
No.
Item M SD SR VI 1
Surface Acting
2.79
0.80
Sometimes
Average 2
Deep Acting
3.17
0.86
OVERALL MEAN
2.98
0.69
Note: Very High= ; High= ; Average= ; Low= ; Very Low=

19. Based on the grand mean of 2. 98 (SD=0
Based on the grand mean of 2.98 (SD=0.69), the summary results indicate that the grand scale response is sometimes which is interpreted as average.
This means that nurses do not usually utilize emotional labor since it requires displaying higher levels of compassion which can cause emotional exhaustion.

20. RELATIONSHIP OD WORK ENVIRONMENT AND SLEEP QUALITY TO SELF-EFFICACY
Interpersonal relationship
0.355**
.000 S
Org. Support
0.281**
Working Condition
0.259**
Overall Work Environment
0.419**
Sleep Quality
0.102
.109 NS
The overall work environment of the respondents shows a significant relationship with self-efficacy (r=0.419 p=0.000). The result implies that the respondents’ work environment is very favourable which results to nurses highly equipped with self-efficacy.
On the other hand, sleep quality was found to have no significant relationship with self-efficacy (p=0.102 r=0.109). The result implies that even though the nurse was not able to have satisfaction in their sleep due to sleep deprivation, their self-efficacy is not affected.
Legend: * Correlation is significant at the 0.05 level
** Correlation is significant at the 0.01 level

21. Confidence in Decision- Making
RELATIONSHIP OF WORK ENVIRONMENT AND SLEEP QUALITY TO CONFIDENCE IN DECISION-MAKING
Confidence in Decision- Making r p VI
Interpersonal relationship
0.285**
.000 S
Org. Support
0.262**
Working Condition
0.221**
Overall Work Environment
0.361**
Sleep Quality
0.092
.149 NS
overall work environment is positively significant to the confidence in decision-making of nurses (r= p= 0.000). In general, the different indicators of work environment contribute 13% to the variance of confidence in decision-making. It implies that the influence of work environment to confidence in decision-making is weak to strong. Also, it implies that work environment affects a nurse’s confidence in decision-making through provision of support, harmonious relationship with colleagues and conduciveness in the work setting.
sleep quality and confidence in decision-making has a coefficient of (p=0.149) which was found to be not significant. This implies that the nurse’s sleep quality does not influence their confidence in decision-making. Thus, irrespective of their sleep quality, their confidence in decision-making is not affected.
Legend: * Correlation is significant at the 0.05 level
** Correlation is significant at the 0.01 level

22. RELATIONSHIP OF WORK ENVIRONMENT AND SLEEP QUALITY TO EMOTIONAL LABOR
Surface Acting
Deep Acting
Overall Emotional Labor r p VI
Interpersonal relationship
-0.078
0.218 NS
0.017
0.791
-0.034
0.588
Org. Support
-.129*
0.042 S
0.587
-0.096
0.132
Working Condition
0.016
0.805
0.063
0.322
0.048
0.449
Overall Work Environment
-0.094
0.772
0.018
-0.042
0.505
Sleep Quality
0.014
0.829
0.454
0.037
0.555
The overall work environment and emotional labor was also not significant with each other (r= p=0.505). The implication indicates that the totality of a nurse’s work environment does not affect the nurse’s emotion regulation in dealing with the patients.
, the correlation of sleep quality to emotional labor was found to be not significant (r=0.014 p= 0.829) as also shown in Table 18. The result implies that no matter what the sleep quality of the nurse is, their regulation of emotions is apparently not affected.
Legend: * Correlation is significant at the 0.05 level
** Correlation is significant at the 0.01 level

23. RELATIONSHIP OF SELF-EFFICACY TO CONFIDENCE IN DECISION-MAKING AND EMOTIONAL LABOR
Surface Acting
Deep Acting
Overall Emotional Labor r p VI P
Self-efficacy
0.650**
.000 S
-0.055
0.385 NS
0.145*
0.022
0.058
0.360
the findings indicate that self-efficacy was significantly related to confidence in decision-making (r=0.650** p= 0.000) at 0.01 level (2-tailed). This implies that those who are competent tend to be confident in making decisions as they perform this tasks and responsibilities.
emotional labor in terms of deep acting, when taking singly is significantly related to self-efficacy (r= p= 0.022). This shows that self-efficacy is positively related to emotional labor in terms of deep acting. This implies that the higher is the nurse’s self-efficacy, the higher is deep acting manifestation.
the self-efficacy and overall emotional labor of the nurses are not significantly related with each other (r=0.058 p=0.360). This implies that the self-efficacy of nurses do not influence the regulation of emotion of the respondents.
Legend: * Correlation is significant at the 0.05 level
** Correlation is significant at the 0.01 level

24. MEDIATION EFFECT OF SELF-EFFICACY ON THE RELATIONSHIP OF WORK ENVIRONMENT AND SLEEP QUALITY TO CONFIDENCE IN DECISION-MAKING AND EMOTIONAL LABOR

25. Based on AMOS, the final model generated shows that work environment has both direct and indirect relationship with confidence in decision-making since self-efficacy mediates their relationship.
Thus, partial mediation occurs

26. CONCLUSION
The respondents had a good work environment and they enjoy a harmonious relationship with their colleagues, adequate support from their organizational managers, and good working conditions.
The better the work environment, the higher the self-efficacy and the confidence of nurses in decision-making. Self-efficacy partially mediates the relationship between work environment and confidence in decision-making.
On the other hand, self-efficacy fully mediates the relationship between work environment and deep acting.

27. RECOMMENDATIONS
Based on the findings and conclusions of this study, the researchers propose the need to conduct the same study while including other variables such as age, years of experience, and shift work.
It is also recommended to include nurses from special units such as emergency room, operating room, critical care services, dialysis and outpatient as respondents for the study.  

28. The researchers also recommend considering other variables that may influence the nurses’ confidence in decision-making.