Exploring Productivity of Nurses in Pakistan’s Health Sector

Fatima Basharat, Iram Fatima, and Kainaat Yousaf*

Institute of Applied Psychology, University of the Punjab, Lahore, Pakistan

*Corresponding Author: [email protected]

Abstract

A correlational study was conducted to examine the relationship between patience, personal belief in a just world and emotion regulation among mothers of toddlers. Using a cross-sectionaldesign, we employed non-probability purposive sampling strategy to recruit mothers (N = 100) of two to four years old children. It was hypothesized that patience and personal belief in a just world would positively predict emotion regulation. It was also expected that personal belief in a just world would moderate the relationship between patience and emotion regulation. Data was collected using the Patience Scale (Fatima & Hafeez, 2013), the Personal Belief in a Just World Scale (Dalbert, 1999), and the Emotion Regulation Questionnaire (Gross & John, 2003). Data was analysed using SPSS version 23. Findings revealed that patience and personal belief in a just world were positively related to emotion regulation. It was also observed that only patience positively predicted emotion regulation. However, the relationship between patience and emotion regulation was not moderated by personal belief in just world. This study had implications for understanding the psychological resources important for emotion regulation while parenting in Pakistani cultural context.

Keywords: patience, belief in a just world, emotion regulation, mothers, toddlers

Introduction

In our daily life, everyone faces barriers in different situations. To live a healthy life, one has to tolerate up to an extent. Patience is the foundation of human life, enabling adaptation in all aspects. True happiness is not found in material abundance but in inner peace. It's essential to teach patience and that everyone experiences trials, ensuring pleasant outcomes (Daughter, 2022). The just world hypothesis, also known as the belief in a just world claims that individuals must have faith that individuals mostly achieve what they deserve as a way to handle the world as for all that it’s stuck down and orderly place. Since this faith works for such an adaptive function, disconfirming it is strongly disruptive, and as an outcome, individuals are strongly motivated to take action to ensure that their faith is regulated (Bartholomaeus & Strelan, 2019). Finally, emotion regulation skills are important for mothers of toddlers, as they can help them manage their own emotions and respondpositivly and constructivly (Rutherford et al., 2015). Emotion regulation is defined by psychologists as the act of beginning, maintaining, and altering one's emotional experience and expression (Wang et al., 2021).

Patience is a quality that develops a practice to experience, satisfaction and success over short and long terms. According to one definition, patience is the prowess to stay patient even in difficulty, misfortune, or agonization (Schnitker, 2012). In today's rapid and demanding society, patience has emerged as a desirable and essential quality that people must have to live successful and satisfying lives, especially in the case of mothers of toddlers where the demand is high and the level of difficulty is far greater (Martinez, 2022).

Individual’s proneness to hold on to the conception of a fair and square society, as explained by Lerner (1980), is the outcome of their desire to exist in a universe that is expected, orderly, and under their control (Dalbert et al., 2001). The idea that if individuals treat others properly, they will be rewarded equally in return and won't experience victimization in the future, the belief in a just world (Lerner, 1980). Belief in a Just World has two main categories i.e., Personal Belief in a Just World and General Belief in a Just World. A personal belief in a just world is the faith that individuals are ultimately held responsible for their deeds and that people ultimately achieve what they earn. On the contrary, the general belief in a just world describes the conviction that generally speaking, the universe is a fair place. It is the propensity to think that, individuals receive what they earn and that fairness always triumphs over injustice (Tatsi & Panagiotopoulou, 2023). For mothers of toddlers the personal belief in a just world as a power that make them more responsible for shaping their emotions in a batter way.

Emotion regulation is the procedure of consciously or unconsciously controlling one's emotions. It involves methods like cognitive reappraisal, expressive suppression, and problem-solving. The task by which we try to control and manage the emotions or feelings we experience and express as well as the emotions we feel and express is known as emotion regulation (Gross, 1998; Gross, 2015a). According to Gross' process model of emotion regulation, Emotion Regulation (ER) tactics can be divided into two categories: cognitive and behavioral methods. The most usual form of ER difficulty in depression, as noted in a previous review by Liu and Thompson (2017), is issues with the habitual use of ER techniques. Frequent use of an ER technique over time can be considered habitual use (Gross, 2014). If you tend to rely on coping mechanisms that make your emotional difficulties worse instead of using methods proven to help (Liu & Thompson, 2017), you may be suffering from dysfunctional habitual ER (Vanderlind et al., 2020).

There was a link between difficulty managing emotions and patience. A quantitative study with 522 students from various Turkish Universities proposed that college students who were patient had fewer emotional problems (Gokcen et al., 2020). Another study on university students studying at Shiraz University, Iran demonstrated that patience was a negative and a significant predictor of difficulties in managing emotions. The inability to manage emotions, the impossibility of occupying in goal-oriented activity, and the lack of access to tools for emotional regulation were all adversely correlated with tolerance. The conclusion of the study was persistence with the notion that patience was crucial in easing emotional control challenges (Khormaei et al., 2016). Similarly, patience had a substantial link with emotional control, the study conducted with 200 nurses who worked in hospitals across Tehran, Iran, indicated that patience has a positive impact on nurses' ability to regulate their emotions and their perception of stress (Sanaati et al., 2018).

Another study aimed at identifying and studying variations in emotion regulation skills between a clinical group of patients with depression as well as a non-clinical group. In contrast to the non-clinical group, the clinical group had considerably lower scores on emotion regulation skill questionnaire scales, as well as lower patience and higher scores on problems in emotion regulation ratings, and vice versa (Compare et al., 2014). In addition to that, different researchers have explained that mindfulness-based therapies may help people to become more patient and better at controlling their emotions. The research study indicates a positive association between patience and emotional regulation after the session of mindfulness (Gross, 2015b).

Another study explored patience and emotional regulation among nurses in Iran, results of which revealed a significant positive association between the dimensions of patience and emotional regulation (Sanaati et al., 2018). Additionally, research conducted on 398 pre-medical students in Italy, also reported a positive relationship between patience and emotional regulation. Patience equipped individuals to handle emotional and interpersonal aspects of  difficult experiences smoothly (Ardenghi et al., 2023).  Another study examined the association between patience and regulation of emotion showed that patience decreased depression and increased  positive affect (Schnitker et al., 2021).

According to a study, patients' individual beliefs in a just world were favorably associated to their emotional sustainment (Megías et al., 2019).  A research conducted to assess the emotional influence of COVID-19 epidemic and general feeling of fairness. The results showed that a high level of general faith in a just world lowered bleak desires and inflated happy sentiments, even during the pandemic. The findings suggest that having the belief of fairness improve emotions even it red alert situations (Wang et al., 2021).

An indigenous study that examined the degrees of patience, individual belief in a just world, and satisfaction with life was conducted with of 347 Chinese College Students. The results demonstrated that one's individual belief in a just world served as a moderator of the relationship between patience and life happiness (Chen et al., 2015). Another study focused on the link between patience, personal beliefs in a just world, and mental health among 505 Taiwanese people. They found that a person's level of belief in a just world influenced the association between patience and mental health. A positive association between patience and psychological well-being was observed among those who exhibited a stronger personal belief in a fair world (Jian et al, 2021).

It could be incredibly difficult for mothers of toddlers to show patience and belief in a just world by controlling their emotions. Toddlers are very young and still learning how to understand and manage their emotions which can cause them to act out or become upset easily. As a result, it could be difficult to remain patient and calm when dealing with a toddler’s outbursts. Furthermore, many mothers of toddlers often find themselves drained from their never-ending responsibilities and lack of sleep, which could make it challenging for them to be patient and remain positive in the face of their child’s outbursts. All of these factors could make it difficult for mothers of toddlers to show patience and believe in a just world by controlling their emotions.

Moreover, Pakistan is a country rich in cultural traditions and values that significantly impact the lives of its people. Exploring this research topic; Patience, Belief in a Just World, and Emotion Regulation in mothers of toddlers in the circumstances of Pakistani culture is especially pertinent due to the unique cultural dynamics and societal expectations that Pakistani women face. Pakistani culture places a strong emphasis on the role of mothers as primary caregivers and the sustainers of harmony in the family. Mothers are expected to be patient, self-sacrificing, and emotionally resilient. However, these expectations could be challenging to maintain emotional well-being. Understanding the cultural context allows us to highlight the specific stressors faced by Pakistani mothers of toddlers and to look at the coping mechanisms they adopt.

Objectives

This study was conducted, keeping in mind, the following objectives: 

• To examine the association between patience, belief in a just world and emotion regulation in mothers of toddlers.
• To substantiate the predicting role of patience and belief in a just world in emotion regulation in mothers of toddlers.

Hypothesis

The subsequent hypothesis laid the foundation for this study:

• Patience and personal belief in a just world would positively relate to emotion regulation in mothers of toddlers
• Patience and personal belief in a just world would positively predict emotion regulation in mothers of toddlers.
• Personal beliefs in a just world (PBJW) would moderate the relationship between patience and emotion regulation.

Hypothesized Model

Method

The method unit explains the approach to conduct this research. It involves the research design, sampling strategy, and assessment measures employed in the study. 

Research Design

A correlational study was conducted, to assess the relationship between patience, belief in a just world, and emotion regulation, among the mothers of toddlers. The cross-sectional research design was exercised in this study.

Sample

The sample consisted of N=100 mothers with toddlers, recruited using non-probability purposive sampling. The data was collected from biological mothers of toddlers, aged 2-4 years, residing in Pakistan. Mothers suffering any kind of physical or psychological condition were not included in the study.

Table 1

Demographic Characteristics of the Participants (N=100)

Assessment Measure

The sample size was N=100 mothers of toddlers, recruited for this research. Data was collected by using a personal information sheet, the Patience Scale, the Personal Belief in a Just World Scale, and the Emotion Regulation Questionnaire.

Personal Information Sheet

A self-build personal information sheet was used to collect information about the socio-demographics of the participants including their age, education, occupation, income, family type, and marital status.

Patience Scale

Patience Scale (Fatima & Hafeez, 2013), developed in Urdu language, measures an individual's capability to endure calmness and content despite diversity. The Patience scale has 52 items that were to be represented on a four-point Likert scale from absolutely false (1) to absolutely true (4). The sample items were, “I do not express anger” and “I wait for good days to come during my bad time”.

Personal Belief in a Just World

To measure a person's view that the person feels, what he or she deserves, the Personal Belief in a Just World Scale (Dalbert, 1999), Urdu version of the tool was utilized in the study. The scale contains a total of seven items. A four-point Likert-type rating scale was used to grade each item, with 4 depicting strongly agree and 1 depicting strongly disagree. According to reports, the Personal Belief in a Just World Scale's Alpha reliability in Urdu language was 93% (Fatima & Khalid, 2007). The sample items were as follows: “I believe, by and large, I deserve what happens to me” and “I believe that most of things that happen in my life are fair.”

Emotion Regulation Questionnaire

The Gross (1998) process model of emotion regulation serves as the foundation for the Emotion Regulation Questionnaire (Gross & John, 2003), a 10-item self-report questionnaire. Urdu translated version (Abbasi & Kazmi, 2022) was used in the current study. The statements were evaluated on a scale from 1 to 7, with 1 being strongly disagree and 7 being strongly agree. The sample items were as follows: “When I want to feel more positive emotion, I change the way I’m thinking about the situation and when I am feeling positive emotions, I am careful not to express them.”

Procedure

The research study was initiated after taking permission from the Institute of Applied Psychology, University of the Punjab. Also permission was obtained from the authors of various scales used. Data was collected from 100 mothers using both online and in-person modalities. Mothers were informed about their rights in writing as well as verbally along with duly signed consent forms, filled out before recording the responses. The privacy and confidentiality of all the participants was maintained. They were also informed about their right to withdrawal at any stage. For in-person data collection, mothers of toddlers were approached personally from the neighborhoods in Lahore. The data was collected through questionnaires from all the consenting participants. In online data collection, consenting mothers were approached using Google Forms through WhatsApp. Participants were appreciated and thanked for their kind participation in the study.

Results

The current study sought to demonstrate the link between patience, belief in a just world, and emotion regulation in mothers of toddlers.

Table 2

Descriptive Statistics and Reliabilities of Patience, Belief in a just world and Emotion Regulation in mothers of toddlers (N = 100)

The above Table 2 shows the means and standard deviations, number of items, reliabilities and maximum and minimum ranges of assessment measures alpha reliability.

Table 3

Correlations of All Study Variables Included Patience, Personal Belief in a Just World, and Emotion Regulation in Mothers of Toddlers (N=100)

Note.**p < .01

A Pearson Product Moment correlation was applied to illustrate the correspondence between patience, belief in a just world and emotion regulation. Results (reported in the above table) indicated a highly significant positive relationship between patience and emotion regulation. Also, depicted a highly significant positive relationship between personal belief in a just world and emotion regulation.

Table 4

Moderation through Hierarchical Regression Analysis of Patience and Emotion Regulation with Personal Belief in a Just World (N = 100)

Note.***p < .001

The above Table 4 shows that, there is no moderating impact of personal belief in a just world between patience and emotion regulation. In Model 1, the R² value of .93 revealed that the predictors explained 93% variance in the outcome with F (1, 98) = 1250.596, p < .001. The findings revealed that personal belief in a just world positively predicted emotion regulation.

In Model 2, the R² value of .96 revealed that the predictors explained 96% variance in the outcome with F (1, 97) = 71.879, p < .001. The findings revealed that patience positively predicted emotion regulation. However, personal belief in a just world did not predict emotion regulation when added with patience In Model 3, the R² value of .96 revealed that the predictors explained 96% variance in the outcome with F (1, 96) = .978, p < .001. Findings showed that personal belief in a just world did not interact with patience to predict emotion regulation.

In a nutshell, both patience and personal belief in a just world were positively related to emotional regulation in mothers of toddlers. However, only patience positively predicted emotional regulation. Further, personal belief in a just world did not moderate the relationship between patience and emotion regulation.

Discussion

In recent years, the conceptualization of patience, belief in a just world and emotion regulation have gained significant attention in the domain of psychology. Emotion regulation entails strategies that  people use to control and cope with their emotional experiences, while patience is defined as an ability to stay calm and steadfast in the face of difficulties or delays. Belief in a Just World is also considered important for mothers of toddlers as it allows them to view their child's behavior as a part of a bigger learning process rather a personal failure. The current investigation manifested correspondence between patience; belief in a just world and emotion regulation among the mothers of toddlers. The study also aimed at examining, if personal belief in a just world influenced emotion regulation of the mothers having  toddlers. Pakistan, a nation with a variety of cultural norms, beliefs, and traditions, have a considerable impact on how its citizens, including mothers, think and act. The study is also of great importance in understanding a mother's emotion regulation in context of Pakistani culture.

It was hypothesized that there would be a positive relationship between patience and emotion regulation and also there would be a positive association between personal belief in a just world and emotion regulation among the mothers of toddlers. The results revealed that patience had a significant positive relationship with emotion regulation, moreover, personal belief in a just world and emotion regulation showed a significant positive association among the mothers having toddlers. This indicates that the quality of patience and capacity for emotional regulation are meaningfully and favorably related. In other words, more patient mothers tend to be better at properly managing and regulating their emotions in dealing with their toddlers. Additionally, there was a significant correlation between a mothers' capacities to regulate their emotions and personal beliefs in a just world. A "just world belief" is a conviction that the world is just and that everyone receives what they merit, good or evil. In this situation, mothers who believed strongly in a just world were more likely to have better emotion regulation (Braatelien, 2020).

This finding aided the hypothesis that personal belief in a just world (PBJW) would be positively related to emotion regulation. Findings were aligned with literature, Tangney et al. (2004) studied relationship between patience and emotion regulation. Their research indicated a positive association between these two. Additionally, research had revealed possible mechanisms underlying this relationship. For example, Dalbert et al. (2001) have showed that personal belief in a just world serves as a cognitive buffer that helps individuals make sense of the world and reduce the negative impact of uncontrolled events. This cognitive buffer, in turn, facilitates adaptive emotion regulation strategies. In addition, it was also recommended that personal belief in a just world could enhance self-esteem and lead to increased self-efficacy in emotion regulation.

It was further hypothesised that patience would positively predict emotion regulation among the mothers of toddlers. It was found that even after controlling for personal belief in a just world, Patience had a unique contribution in emotion regulation. Mothers with an increased patience levels were better equipped to regulate emotions. Existing research suggests that patience has a significant impact on emotional regulation in mothers of young children. A study by Mikolajczak and Roskam (2018) found that mothers' patience positively impacted their capability to modulate their emotions. The capacity to regulate emotions effectively laeds overall parenting practices and results in better outcomes for children. For mothers of toddlers, patience is vital for emotional regulation because it helps them stay calm during tantrums, communicate effectively with their children, and remain resilient in the face of parenting challenges thus reducing the risk of becoming overwhelmed by negative emotions.

It was also expected that personal belief in a just world would positively predict emotion regulation. However, results indicated that personal belief in a just world was not a significant predictor of emotional regulation. The finding was inconsistent with literature (Liu & Ma, 2019). The reason may be the suppressor effects that need to be catered in the futurestudies.

Another hypothesis was that personal belief in a just world would moderate the association between patience and emotion regulation. The findings suggested that personal belief in a just world did not moderate the association between patience and emotion regulation indicating individuals' level of patience was not influenced by their belief in a just world when it comes to regulation of emotions. A study that looks at the connection between patience, emotion regulation, and personal belief in a just world. They discovered no consequential interaction impact of personal belief in a just world and patience on emotion regulation. This implies that personal faith in a just universe has no effect on the link between patience and emotion management (Smith et al., 2023). A cross-cultural study was also conducted to investigate the moderating effect of personal belief in a just world on the association between patience and emotional control in different cultural contexts. Their findings were consistent across cultures, indicating that, independent of cultural differences, personal belief in a just universe did not affect the association between patience and emotion regulation (Kwon et al., 2013). Patience is about managing reactions to challenges, while belief in a just world relates to fairness perceptions.

Conclusion

In conclusion, this study highlighted the significance of patience, belief in a just world, and emotion regulation in promoting favorable maternal outcomes and encouraging healthy infant development. Mothers’ contributions to the nurturing and upbringing of their children are highly valued in Pakistani society. But this duty frequently comes with many difficulties and tensions that can harm a mother's emotional health. Research shows that women patient were more likely to maintain composure and adress their children's needs in a calm and collectedmanner. Their optimistic attitude enablethem regulate their emotions and handle their problems in a constructive way.

Limitations and Suggestions

Existing research relies on self-reported measurements, which can result in biases and may involve social desirability. Cultural factors such as religious beliefs, social norms, and extended family involvement can significantly influence maternal caregiving behavior and should be considered in future research. A combination of qualitative and quantitative methods can be utilized to thoroughly understand the experiences of Pakistani mothers and their unique cultural contexts. It is suggested that longitudinal studies may help understand how patience, belief in a just world, and emotional regulation influence parenting over time.

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