Relationship of Resilience and Self-Efficacy with Work Engagement Among Cardiac Nurses in Public Sector Hospitals of Karachi

Logical Creations Education Research Institute MADER E MILAT INTERNATIONAL JOURNAL OF NURSING AND ALLIED SCIENCES E-ISSN: 2960-2181 Web: www.minasij.com | Email: [email protected] Volume-03 | Issue-03 | September-2025 Published by Logical Creations Education Research Institute. www.lceri.org.pk 1 This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) Relationship of Resilience and Self-Efficacy with Work Engagement Among Cardiac Nurses in Public Sector Hospitals of Karachi Moinuddin1*, Hassan Raza2, Sohaib-uz-Zaman3, Bilal Adnan4 1Principal, Department of Nursing, Patel Institute of Nursing and Allied Health Sciences, Karachi-Pakistan. 2Chief Pharmacist, Ojha Institute of Chest Diseases, Dow University of Health Sciences, Karachi-Pakistan. 3Assistant Professor, Karachi University Business School, University of Karachi, Karachi-Pakistan. 4Data Scientist, Dow University of Health Sciences, Karachi-Pakistan. moin.duh[email protected], hassan.[email protected]u.pk*, [email protected]k, [email protected] DOI: 10.5281/zenodo.17461800 ABSTRACT Nurses make up a significant portion of the health care workforce and directly interact with patients daily, which inherently makes them important players in achieving quality care and positive patient outcomes. The purpose of the present study was to understand the relationship between self-efficacy, resilience, and work engagement among nurses working in cardiac units of two public sector hospitals of Karachi by using a cross-sectional study design (n= 162). Work engagement was assessed through standardized Utrecht Work Engagement Scale (UWES), while general efficacy is analyzed through the General Self-Efficacy Scale (GSE), and Resilience is determined through the Connor-Davidson Resilience Scale (CD-RISC). The Study analysis was done using Pearson's correlation and multiple regression in RStudio Software. The result of the study shown a significant positive correlation between resilience and work engagement (r = 0.53, p < 0.001), and between self-efficacy and work engagement (r = 0.56, p < 0.001) and multiple regression analysis also confirmed that both resilience and self-efficacy are significant predictors of work engagement, together accounting for 34% of the variance (R2=0.34). These findings suggest that both traits are crucial for enhancing and sustaining work engagement, allowing nurses to proactively address challenges and remain actively involved in their work. Keywords: Resilience, Self-efficacy, Work engagement, Registered nurse, Utrecht Work Engagement Scale, Connor-Davidson Resilience Scale, General Self-Efficacy Scale (GSE). Cite as: Cite as: Moinuddin, Hassan Raza, Sohaib-uz-Zaman, Bilal Adnan (2025). Relationship of Resilience and Self-Efficacy with Work Engagement Among Cardiac Nurses in Public Sector Hospitals of Karachi. Mader e Milat International Journal of Nursing and Allied Sciences, 3(3), 1– 15. https://doi.org/10.5281/zenodo.17461800 INTRODUCTION Work engagement is an enthusiastic and rewarding mental state where people feel energized, committed, and engrossed in their jobs and it is positively associated with employee’s wellbeing and performance (Halbesleben et al., 2010). Literature also associates it with positive organizational outcomes (Bakker et al., 2011). This positive association of organizational outcomes like increase job performance, productivity, and financial benefits with work engagement have stimulated recent interest Logical Creations Education Research Institute MADER E MILAT INTERNATIONAL JOURNAL OF NURSING AND ALLIED SCIENCES E-ISSN: 2960-2181 Web: www.minasij.com | Email: [email protected] Volume-03 | Issue-03 | September-2025 Published by Logical Creations Education Research Institute. www.lceri.org.pk 2 This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) in registered nurses as health care systems around the work are striving to cope with increasing demands of nurses and limited resources (Antoinette Bargagliotti, 2012; Fasoli, 2010). Nursing is a very stressful occupation. Registered nurses make up a significant portion of the health care workforce and directly interact with patients daily, which inherently makes them important players in achieving quality care and positive patient outcomes (Cummings, 2013). Moreover, internal job satisfaction and proactive engagement by nurses as caregivers has also been linked with increased patient satisfaction (De Simone et al., 2018). Providing efficient nursing care to patients requires timely completion of many tasks simultaneously. This Multitasking creates numerous challenges for nurses in a resource-limited environment which compromises nurses' work engagement. Tackling these challenges requires efficient work engagement and other individual-level protective traits such as resilience, self-regulation, and self-efficacy. Resilience is defined as the capacity to respond quickly and constructively to crises (Ovans, 2015). Litearture reveals a strong positive association between Resilience and job satisfaction, contributing to improved staff retention (Kašpárková et al., 2018). Literature identifies confidence, adjustability, creativity, patience, competencies, being a proactive team member, maintaining professional boundaries, decisiveness, charisma, and a sense of self-reliance as important individual traits which make an employee resilient (Hart et al., 2014). Resilience plays protective role against nurses’ turnover, post-traumatic stress disorder, and burnout (Arrogante & Aparicio-Zaldivar, 2017; McAllister & McKinnon, 2009; Mealer et al., 2017) Nurses, particularly those in critical care units, frequently encounter adversities and uncertainties, exposing them to various work-related stressors (Bhatti et al., 2018). The prolonged or frequent challenges of rising infectious diseases, scarcity of resources, burnout, exhaustion, organizational injustice can deplete psychological reserves, leading nurses to develop diverse coping mechanisms often rooted in personal protective factors. (Ahmad et al., 2021; Shi et al., 2019). Self-regulation is defined as the ability to develop, implement, and sustain planned behaviors to achieve one's goals (Bagozzi, 1992). It is considered a vital factor to overcome the challenges under pressure situations. In many parts of the world nursing profession is a self-regulated profession, thereby nurses predominantly control their own admission standards and requirements as well as norms for its practice. Being granted a status of self-regulation is a recognition that the profession itself is best qualified to define the practice and boundaries of its own profession (Schiller, 2015). Self-efficacy acts as a foundational component for self-regulation which refers to as an individual's belief in their ability to succeed at a task (self-efficacy) directly impacts their willingness and capacity to use self-regulatory strategies. Both self-regulation and self-efficacy are considered significant personal protective factors and key predictors of nurses' clinical efficiency (Khan, 2024; Schunk, 2023). In rapidly evolving clinical environments, the dynamic nature of self-regulation proves both effective and efficient. Ultimately, when coupled with work engagement, self-efficacy can significantly enhance performance. Objective of the study The study is based on Job Demand Resource Model, and it will empirically investigate that in extreme Job Demands (High Workload especially critical care areas) in Karachi, do personal resources like selfefficacy and resilience help nurses sustain work engagement, thereby preventing Burnout and retaining workforce. Therefore, the prime objective of this study is to investigate the relationship between resilience, self-efficacy, and work engagement among cardiac nurses in Karachi's public sector hospitals. Logical Creations Education Research Institute MADER E MILAT INTERNATIONAL JOURNAL OF NURSING AND ALLIED SCIENCES E-ISSN: 2960-2181 Web: www.minasij.com | Email: [email protected] Volume-03 | Issue-03 | September-2025 Published by Logical Creations Education Research Institute. www.lceri.org.pk 3 This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) Hypothesis • There is a significant positive association between resilience and the work engagement of cardiac nurses in public sector hospitals of Karachi. • There is a significant positive association between self-efficacy and the work engagement of cardiac nurses in public sector hospitals. Significance of the problem The healthcare infrastructure of Karachi is currently facing significant strain due to surge in communicable diseases like malaria, Tuberculosis Chikungunya, dengue and non-communicable diseases, brain drain, critical shortage of skilled nurses and educational gaps (Haq et al., 2025; Meo & Sultan, 2023). Hospitals are reporting elevated patient load due to poor conditions and infrastructure of the city which leads to an oversaturation of the medical facilities (Ayub, 2024) resulting in increased occupational stress in nurses of Pakistan (Ghanei Gheshlagh et al., 2025). Therefore, this empiric investigation of interrelationship between resilience, self-efficacy and work engagement among Pakistani Nurses in critical care have profound significance for multiple stakeholders. First and the foremost this study will provide a psychological profile of the most vulnerable and most engaged nurses thereby it will help policymakers to develop target, evidence-based wellness program focused on building coping mechanisms. Secondly this study will establish the relationship between psychological capitals and work engagement, thereby it will help policymakers to devise strategies for resource retention. Third the results of the study will give quantitative evidence for National Policy Advocacy to standardize compensation, reduce nurse to patient ration and promote nurses to leadership roles. LITERATURE REVIEW Work engagement characterized by vigor, dedication and absorption is consistently linked to higher nurse satisfaction and retention. Vigor is characterized by high levels of energy, mental resilience, a desire to invest in work, and persistence despite difficulties. Dedication refers to a sense of significance, enthusiasm, inspiration, pride, and challenge. Absorption refers to complete concentration and happy engrossment in work (W. B. Schaufeli & Bakker, 2004). Engaged nurses report less emotional exhaustion, compassion fatigue, and burnout (Cao & Chen, 2021). Studies also reports that male nurses show more work engagement than their female counterparts (Cao & Chen, 2019). As stated, this study is an extension of the Job demand model which is frequently being used to investigate the antecedents and outcomes of work engagement in literature. The model is based on two contrasting but supporting variables one is job demands that commence health impairment process, which leads to negative health-related outcomes. In contrast, job and personal resources initiate a motivational process through which positive performance-related outcomes can be achieved. Burnout mediates the relationship between job demands and negative health-related outcomes in the healthimpairment process, whereas work engagement mediates the relationship between resources and positive outcomes in the motivational process (Bakker & Demerouti, 2008). However, this study relates these variables to Self-regulation, and Resilience which are associated with personal resources and selfregulation and self-efficacy both are also considered as critical drivers for nurses’ clinical efficiency according to published literature (De Simone et al., 2018). The demanding nature of nursing job requires nurses to be very highly self-efficacious, demonstrating strong leadership and emotional Logical Creations Education Research Institute MADER E MILAT INTERNATIONAL JOURNAL OF NURSING AND ALLIED SCIENCES E-ISSN: 2960-2181 Web: www.minasij.com | Email: [email protected] Volume-03 | Issue-03 | September-2025 Published by Logical Creations Education Research Institute. www.lceri.org.pk 4 This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) capacities. Studies reflect that these emotions capabilities are positively associated with nurse’s performance especially in critical care units (van Mol et al., 2018). These Resources, especially Self-Regulation is found to be positively related to Job satisfaction of nurses, and it is found to be core strength of nurses in leadership role (Alabdulbaqi et al., 2019; Cao & Chen, 2021) Literature has reported positive association of Resilience and Work engagement particularly in nursing profession (Cao & Chen, 2019). Therefore, this study is exploring the relationship of resilience and Self Efficacy with work Engagement of Nurses in Pakistan especially those who are working in critical care. Since in Pakistan, healthcare workers face significant mental health challenges due to high job demands and limited resources (Khan, 2024). The scope of this study is limited to Public Sectors Hospitals only as studies reports Public Sector hospitals are more under-resourced and understaffed, leading to heavy workloads and long working hours for nurses (Abbas, 2025). This is compounded by low pay and job insecurity, which further contribute to high stress levels and a heightened risk for mental health disorders like anxiety, depression, and burnout (Akhtar et al., 2025). Moreover, Nurses of Public Sector Hospital of Pakistan are inadequately trained and have limited support from the ancillary services like Pharmacy, Administration, increasing their susceptibility to these mental health issues (Khan, 2024). METHODOLOGY Ethical Approval and Considerations Relevant approvals were taken prior to the data collection of the study. All participants were provided with comprehensive information about the study. Written informed consent was also obtained from each participant. The participation was completely voluntary in nature, and participants were also informed that they can withdraw at any time. Confidentiality of all participants’ information was strictly maintained. The anonymity of the participants was also ensured through the study and will also be ensured in the future as well. Study Design A cross-sectional design was used to evaluate the relationships between resilience, self-efficacy, and work engagement in a sample of cardiac nurses. Study Setting The data for the study was conducted in the cardiovascular units of two prominent public sector hospitals in Karachi: Dow University Hospital and Dr. KM. Ruth Pfau Civil Hospital, Karachi. Study Population and Sampling Technique The target population comprised registered nurses working in the selected units of these two public sector hospitals in Karachi. A non-probability, convenience sampling technique was employed due to the accessibility of participants within the demanding clinical environment. Sample Size Data were collected from a total of 162 registered nurses. The sample size was determined based on feasibility and resource availability within the study timeframe through power analysis (Dupont & Plummer, 1998). Logical Creations Education Research Institute MADER E MILAT INTERNATIONAL JOURNAL OF NURSING AND ALLIED SCIENCES E-ISSN: 2960-2181 Web: www.minasij.com | Email: [email protected] Volume-03 | Issue-03 | September-2025 Published by Logical Creations Education Research Institute. www.lceri.org.pk 5 This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) For our power analysis, we used the following parameters: Alpha (α): 0.05 (This is the standard threshold for statistical significance.) Power: 0.80 (This means there is an 80% chance of detecting a real effect if one exists.) Number of Predictors (k): 2 (Our independent variables are resilience and self-efficacy.) We used Cohen's conventional guidelines to calculate the sample size needed to detect small, medium, and large effects (Aguinis & Harden, 2010). This approach helps to create a robust study design that accounts for different possible outcomes. Using the given parameters (α=0.05, Power = 0.80, k=2), the minimum sample size requires for small to medium effect was 55 participants while we have conducted the study on 162 participants which well above the required sample size. Study Duration The research was carried out for seven months, commencing after approval from the IRC was received. Inclusion Criteria Registered Nurses (RN) actively working with cardiovascular patients in the selected healthcare facilities for a minimum of two years. Registered Nurses who provided their informed written consent voluntarily before data collection. Exclusion Criteria Cardiac nurses primarily involved in indirect patient care (e.g., those caring primarily for patients diagnosed with non-cardiac chief complaints, or those in purely administrative roles). Part-time cardiac nurses (e.g., those working on a locum basis or as temporary replacements). Data Collection Tools This data was collected through pre-validated standards questionnaires, and the questionnaire was comprised of two parts: Demographic Characteristics: A self-developed section to collect information on participant age, gender, work experience, education level, income status, and hospital setting. Validated Psychometric Scales: Utrecht Work Engagement Scale (UWES-17): This 17-item scale measures work engagement across three dimensions: Vigor, Dedication, and Absorption. Participants. (W. Schaufeli & Bakker, 2003). The participants were asked to respond on 7-Point Likert scale. The higher points indicate greater work engagement. General Self-Efficacy Scale (GSE): This is a 10-item Questionnaire having 4-point likert scale, which is used to assess an individual’s belief in their ability to cope during challenging situation. (Schwarzer & Jerusalem, 1995). Connor-Davidson Resilience Scale (CD-RISC-25): This is a 25-item scale with a 5-point Likert scale, which measures perceived resilience(Connor & Davidson, 2003). Logical Creations Education Research Institute MADER E MILAT INTERNATIONAL JOURNAL OF NURSING AND ALLIED SCIENCES E-ISSN: 2960-2181 Web: www.minasij.com | Email: [email protected] Volume-03 | Issue-03 | September-2025 Published by Logical Creations Education Research Institute. www.lceri.org.pk 6 This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) DATA ANALYSIS AND RESULTS Data Analysis RStudio software version 4.5.1 was used to analyze the data of the study. Demographic characteristics are explained in Table 1 using frequency and percentages. Pearson coefficient is used to investigate the relationships between the categorized levels of resilience and self-efficacy with work engagement as recommended in literature (Obilor & Amadi, 2018). Demographic Characteristics of the Participants Sample demographic details are shown in table 1. Almost all the participants were male (n=154, 95.06%), with most participants (n=140, 86.42%) falling within the 20-29 age group and were unmarried (n=122, 75.31%). This gender imbalance resulted from a convenience sampling approach, as the data was collected from cardiac care settings where male nurses are more prevalent. About education, a significant majority, 128 (79.01%), held a Bachelor's degree. The rest of the participants were a mix of Matric and Doctorate degree holders. A large proportion of the nurses, 124 (76.54%), were Staff Nurses, while others held Manager or Incharge roles. Concerning work experience, the most common category was 1-3 years and 3-5 years, both with 60 participants (37.04%). Only 7 (4.32%) had 10 years and above of experience. The full breakdown of work experience is detailed in Table 1. For monthly income, 100 (61.73%) earned under 50,000 PKR, and 40 (24.69%) earned 51,000 – 100,000 PKR. 15 (9.26%) earned between 101,000–150,000 PKR, and 7 (4.32%) earned 151,000 PKR and above. Table 1: Demographic Characteristics of the Study Participants Marital status Frequency Percentage Single 122 75.31% Married 38 23.46% Widow 0 0.00% Divorcee 2 1.23% Gender Frequency Percentage Male 154 95.06% Female 8 4.94% Education Frequency Percentage Matric 32 19.75% Bachelor 128 79.01% Masters 0 0.00% MPhil 0 0.00% Doctorate Degree 2 1.23% Others 0 0.00% Logical Creations Education Research Institute MADER E MILAT INTERNATIONAL JOURNAL OF NURSING AND ALLIED SCIENCES E-ISSN: 2960-2181 Web: www.minasij.com | Email: [email protected] Volume-03 | Issue-03 | September-2025 Published by Logical Creations Education Research Institute. www.lceri.org.pk 7 This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) Designation Frequency Percentage Manager 35 21.60% Incharge 3 1.85% Staff Nurse 124 76.54% Social Income Class Frequency Percentage Lower 41 25.31% Working Middle 74 45.68% Upper Middle 35 21.60% Upper 12 7.41% Age Frequency Percentage 20-29 Years 140 86.42% 30-39 Years 15 9.26% 40-49 years 5 3.09% 50-59 Years 1 0.62% 60 or above 1 0.62% Work experience Frequency Percentage Less than 1 Year 20 12.35% 1 - 3 Years 60 37.04% 3 - 5 Years 60 37.04% 5 - 10 Years 15 9.26% 10 Years and above 7 4.32% Work hours Frequency Percentage 6 Hours 100 61.73% 8 Hours 50 30.86% 12 Hours 12 7.41% Income Frequency Percentage Under 50,000 PKR 100 61.73% 51,000 – 100,000 PKR 40 24.69% 101,000P KR – 1,50000 PKR 15 9.26% 151,000 PKR and above 7 4.32% Logical Creations Education Research Institute MADER E MILAT INTERNATIONAL JOURNAL OF NURSING AND ALLIED SCIENCES E-ISSN: 2960-2181 Web: www.minasij.com | Email: [email protected] Volume-03 | Issue-03 | September-2025 Published by Logical Creations Education Research Institute. www.lceri.org.pk 8 This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) CD-RISC Scale 25 Table 2: Overall CD-RISC Scale 25 Score Type Mean Maximum possible value Total CD-RISC-25 Score 86.64 125 Strength Score 7.32 10 Tenacity Score 17.81 25 Control Score 3.44 5 Overall Resilience (Total CD-RISC-25 Score): The mean total CD-RISC-25 score for the sample was 86.64 (out of a possible 125). This score represents approximately 69.3% of the maximum possible resilience score, indicating that, on average, participants in this study demonstrate a moderately high level of overall resilience. The observed scores ranged from a minimum of 48 to a maximum of 115, suggesting considerable variability in resilience levels across the sample, encompassing individuals with both lower and higher capacities to cope with adversity. The standard deviation of 17.49 further supports this moderate dispersion of resilience levels among the participants. Subscales of CD-RISC-25: The resilience of the participants was further analyzed across the three distinct sub-scales of the CD-RISC-25. Strength Score (Mean = 7.32): This subscale assesses a sense of personal strength, confidence derived from past successes, and belief in one's ability to cope with difficulties. Our study shows a mean score of 7.32 (out of a possible 10), which indicates the participants of our study exhibit a strong sense of personal capability and confidence in their past achievements, contributing positively to their overall resilience. Tenacity Score (Mean = 17.81): This subscale assess persistence, perseverance, and the ability to maintain effort despite obstacles. Out study shows a mean score of 17.81 (out of a possible 25) which indicates that the participants of our study shows a strong inclination to exert their best effort, believe in achieving their goals despite challenges, and exhibit a notable reluctance to give up, even when faced with difficulties. Control Score (Mean = 3.44): This subscale measures the belief in maintaining personal control during stressful times. Our study shows the mean score of 3.44 (out of a possible 5) for our participants which suggests our participants possess a healthy perception of their ability to influence outcomes in challenging situations. Collectively, these findings suggest that the study participants demonstrate robust resilience. Overall Work Engagement (UWE Scale): UWES uses 3 scales—vigor, dedication, and absorption—to quantify the degree of work involvement. It is an instrument that serves to gauge employee engagement in the workplace both individually and collectively. Logical Creations Education Research Institute MADER E MILAT INTERNATIONAL JOURNAL OF NURSING AND ALLIED SCIENCES E-ISSN: 2960-2181 Web: www.minasij.com | Email: [email protected] Volume-03 | Issue-03 | September-2025 Published by Logical Creations Education Research Institute. www.lceri.org.pk 9 This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) Table 3: Descriptive Statistics of UWES Score Type Mean Standard Deviation Maximum Possible Score Overall UWES Score 66.12 12.77 102 Vigor Score 22.96 0.86 36 Dedication Score 19.26 0.85 30 Absorption Score 23.9 0.94 36 Overall Work Engagement (Total UWES Score): The mean total UWES score for the sample was 66.12 out of a possible 102. This score represents approximately 64.8% of the maximum possible work engagement score. This indicates that, on average, participants in the study demonstrate a moderate to high level of overall work engagement. The standard deviation of 12.77 indicates a fair amount of variability in work engagement levels among the participants, suggesting a diverse range of experiences from individuals with lower to higher engagement. Subscales of Work Engagement: The UWES-17 measures work engagement across three distinct subscales. Vigor Score (Mean = 22.96 out of 36): This subscale assesses the levels of energy and mental strength and resilience at work. Our study shows a mean score of 22.96 out of 36, which indicates that the participants of the study generally perceive good energy levels and mental resilience. Dedication Score (Mean = 19.26 out of 30): This subscale asses the perception of sense of involvement, enthusiasm, inspiration, pride, and challenge. Our study shows the mean score of 19.26 out of 30, which suggests that participants generally find their work meaningful and purposeful, demonstrating enthusiasm and pride in their job. Absorption Score (Mean = 23.90 out of 36): This subscale asses the perception of concentration during work. Our study shows a score of 23.90 out of 36 maximum possible score, which shows participants tend to feel quite immersed and engrossed in their work. Overall, the findings from the UWES-17 indicate that the study participants demonstrate a moderate to high level of work engagement across all three dimensions. Overall General Self-Efficacy (GSE) GSE is a 10-item psychological scale used to measure people's optimism and ability to handle a wide range of demanding situations in life. Table 4: Results of Overall GSE: Metric Value Maximum Possible Score Mean 30.07 40 Standard Deviation (SD) 4.67 Median 30 The mean score of GSE is 30.07 out of a possible 40 with a Standard Deviation of only 4.67 indicates that participants possess a moderately high level of perceived general self-efficacy. Internal Consistency Analysis: The internal consistency analysis was also performed using Cronbach's Alpha, all three scales demonstrated good to excellent reliability. The UWES-17 showed an overall scale alpha of α=0.788, which is considered acceptable. The CD-RISC and GSE exhibited a very high level of internal consistency with an alpha of α=0.91 and α=0.831 respectively. Since all three scales produced alpha