Relationship between Professional Behavior and Cognitive Dissonance in Nurses Working in Teaching Hospitals

Relationship between Professional Behavior and Cognitive Dissonance in Nurses Working in Teaching Hospitals | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Relationship between Professional Behavior and Cognitive Dissonance in Nurses Working in Teaching Hospitals Maryam Asri, Abolfazl Hossein-Nataj, Vida Shafipour, Hamideh Azimi Lolaty This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8521538/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and Purpose Regarding the direct connection between nurses and patients and the increasing focus on promoting professional behavior, it is highly critical to recognize and examine the factors influencing professional behavior. Cognitive dissonance arises when two or more cognitive elements are conflicting and is followed by psychophysiological impacts and may affect behavior. Thus, the current study was conducted pursuing the goal to find out the relationship between professional behavior and cognitive dissonance among the nurses working in the teaching hospitals of Mazandaran University of Medical Sciences. Material and Methods In this descriptive-analytical study, 235 nurses working in the wards of teaching hospitals affiliated with Mazandaran University of Medical Sciences were randomly selected by stratified sampling method. The study tools encompassed a demographic checklist, Harmon-Jones Dissonance Arousal and Reduction Questionnaire (DARQ), and Goze , s Nursing Students Professional Behavior Scale(NSPBS). The statistical analysis was done by descriptive statistics, Pearson correlation coefficient, t-test, ANOVA, and multiple linear regression using SPSS-22. In all cases of statistical analysis, the level of significance less than or equal to 0.05 (P ≤ 0.05) was taken into account. Results The current study drawn results revealed that 80.9% of nurses were women with the mean age and work experience of 32.90 ± 7.74 and 8.43 ± 7.46, respectively. Besides, the participants’ nursing professional behavior score was 109.79 ± 14.55 and cognitive dissonance score was 83.11 ± 9.45. The findings also reported a direct significant relationship between professional behavior and cognitive dissonance reduction (increased score) (P = 0.00, r = 0.256). Conclusion The study findings displayed the mean score of nursing professional behavior as high, and the mean score of cognitive dissonance was in the range of dissonance reduction. In other words, the higher the mean score of Dissonance Arousal And Reduction Questionnaire, the lower the level of dissonance-induced arousal and higher ability to reduce negative dissonance-induced feelings(defind as consonant cognition). Professional Behavior Cognitive Dissonance Nursing Behavior Introduction In recent decades, the term professional behavior has been considered fundamental in the education and clinical practice of medical sciences, particularly nursing ( 1 , 2 ). Professional behavior involves the provision of nursing care based on values and norms appropriate to the profession. Such care is compatible with specific behavioral standards realized through the acquisition of knowledge, attitudes, and skills, leading to commitment to the profession and enhanced nursing performance ( 3 , 4 ). Novice nurses learn professional behavior in various ways, mainly by observing how others behave ( 5 , 7 ). Numerous reports display unprofessional and unethical behavior occurring in different departments of university hospitals ( 7 ). Patients’ physical and mental health is directly linked with the quality of nurses' performance and professional behavior, so it is highly critical to focus on cultivating and promoting professional behavior in nurses. Besides, promoting professional behavior in nurses leads to increasing the quality of service provision by nurses and patient satisfaction, upgrading the productivity of health centers, lifting job satisfaction and motivation, and decreasing their physical and mental fatigue ( 1 , 5 ). The studies done in Iran reported the rate of professional behavior based on Goz Nursing Students Professional Behavior Scale (NSPBS) as 104–113, which is considered high ( 1 , 2 , 4 , 5 , 7 , 8 ). Professional behavior and the quality of care provided by nurses are associated with many factors ( 5 ). What is vividly grasped from the reports is that if the decline in the quality of care occurs gradually, it usually does not provoke a reaction from the managers of health centers; this gradual reduction in the quality of care and not paying attention to it causes gradual increase in the violations of standards, declining performance, and ultimately, providing faulty care to patients ( 9 ). In most cases, deficient care provision is not due to low level skills in nurses or lack of compassion and empathy in them; rather, it is because they are trying to provide service to a large number of patients and are simultaneously under pressure due to responding to the demands of managers, the deprivation of resources, and excessive stress ( 10 , 11 ). In some cases, hospital policy and management paves a ground that ultimately forces staff to do things in contrast to their judgment and beliefs ( 9 , 12 ). Under such circumstances, the personnel’s attitudes, beliefs, and behaviors may conflict with each other ( 13 – 16 ). Cognitive dissonance is defined as a mental phenomenon in which individuals unknowingly hold fundamentally conflicting cognitions. As proposed by Leon Festinger, human beings always strive for intern psychological consistency to maintain coherence and harmony between their attitudes, cognitions, and values, and the existence of some kind of incoherence and inconsistency between them creates a disturbing state referred to dissonance ( 16 – 19 ). This reconciliation in the brain's cognitive processes is required for basic mental functions such as problem solving, decision-making, and interactions ( 20 ), and it also leads to peace and comfort ( 21 ). Conversely, the more dissonance there is, the more unpleasant emotions are experienced, which may affect one’s memory, attention, or problem-solving and decision-making potentials ( 9 , 14 , 15 , 18 , 19 , 22 ). Various studies revealed the occurrence of dissonance being correlated with various factors such as interpersonal interaction, mental structure, self-esteem, personality traits, the presence of a source of control, and a positive self-concept ( 13 , 17 ). Dissonance can manifest itself in the form of guilt, shame, stress, regret, or anger, which subsequently brings about psychophysiological consequences like increased heart rate, higher blood pressure, and impaired decision-making and learning processes. The outbreak of such a negative feeling in an individual motivates them to take measures to modify the situation and reduce dissonance ( 23 – 25 ). The approach an individual adopts to lower dissonance leads to positive or negative performance ( 26 ). Individuals may apply various short or long term strategies for dissonance reduction: Denial, trivializing dissonant cognition, creating new consonant cognition, providing justifications to defend oneself, changing one's attitude, or blaming others are examples of such strategies ( 9 , 17 , 23 , 25 , 27 , 28 ). Despite the importance of this issue, no study has been performed to outline the relationship between professional behavior and cognitive dissonance; thus, the current research was done to find out the association between professional behavior and cognitive dissonance among the nurses working in university hospitals of Mazandaran University of Medical Sciences in 2024. Material and Methods This descriptive-analytical correlational study was conducted at Mazandaran University of Medical Sciences in 2024. This study sample size was calculated using the research of Khajavi et al., in which the mean of professional behavior was reported as 113.33 ± 13.66 (1). Considering Type I error of 5% and the power of test (1- β) of 80%, the measurement error (d) of 2.5 units is given by the following formula: Since the current study was a cross-sectional study, sample attrition was not taken into account and totally, 235 samples were calculated. Then, sampling was done as Stratified random sampling . For this purpose, after calculating the statistics on the total number of nursing staff working in the the teaching hospitals of Mazandaran University of Medical Sciences in Sari, each hospital was viewed as a strata and the required sample was estimated in each hospital. To access the samples in each hospital, based on the total list of nurses in each hospital, the required number of samples was chosen and the wards where the selected nurses worked were visited. Observing the inclusion and exclusion criteria, ethical considerations and filling out the informed consent, the questionnaire was distributed among them and completed. The study inclusion criteria were having at least 6 months of continuous work experience in the question hospital and having a bachelor's or higher degree in nursing, and the exclusion criteria included reluctant to cooperate and being in the position as a nursing manager (like head nurses, matrons, supervisors). To do this study, a demographic checklist (the results of which are given in Table 1), the Harmon-Jones Dissonance Arousal and Reduction Questionnaire, and Nursing Students’ Professional Behavior Scale were utilized. 1. Harmon-Jones Dissonance Arousal and Reduction Questionnaire (DARQ): This questionnaire was developed by Harmon-Jones et al. (2008) pursuing Leon Festinger's Theory of Cognitive Dissonance made up of 25 items and 2 subscales: arousal (12 items) and dissonance reduction (13 items). The questionnaire is scored on a Likert scale, with scores of 1, 2, 3, 4, and 5 for the options "Never," "Rarely," "Sometimes," "Often," and "Always," respectively. The items on the arousal subscale are reversely scored. To gain the questionnaire’s total score, the scores of all items are added together. The min and max scores from this questionnaire are 25 and 125, respectively. Scores less than 36 stand for excessive arousal and increased dissonance. In fact, those whose total scores are less than 36 are unable to reduce negative dissonance-induced feelings. Scores greater than 66 indicate excessive reduction of arousal and dissonance, which means the individuals whose total scores are greater than 66 reduce their arousal in dissonance-provoking situations (29). Since dissonance reduction means creating harmonious internal state, it can be stated that getting a high score on the DARQ actually signals the potential for harmony buildup (dissonance reduction). Saffarinia and Zandi (2010) administered the questionnaire to 528 students at Payam-e-Noor University in Tehran to test the questionnaire’s psychometric properties in Iran population. The internal correlation of the items displayed three items having a negative or poor correlation with the rest of the questionnaire items. Thus, they were removed and the number of items reduced to 25 from 28. In the study drawn results, the Cronbach's alpha coefficient was 0.827, and the reliability coefficient of the Dissonance Arousal and Reduction subscales was reported by Cronbach's alpha method as 0.74 and 0.84, respectively. (29). In this study, the reliability coefficient of the DARQ’s subscales reported by Cronbach's alpha was 0.83 and 0.76, respectively. Besides, the Cronbach's alpha for the whole questionnaire was 0.79, which indicates the scale’s reliability as appropriate in measuring the desired variable. 2. Nursing Students’ Professional Behavior Scale (NSPBS) The NSPBS developed by Goz et al.: This scale is a modified version of the Goz and Geckil’s Nursing Students Professional Behavior Scale (NSPBS), which was employed in Iran and also in our research in order to measure the nurses' professional behavior. The 27-item scale in the form of a Likert scale including 5 options: "Always", "Often", "No opinion", "Sometimes" and "Not at all", each of which is scored 5, 4, 3, 2 and 1, respectively. The scores gained from this scale are 27 and 135 as the min and max values, and scores 27-63 are considered low, scores 64-100 moderate and scores 101-135 higher, professional behavior (5). This questionnaire does not have components (dimensions or sub-variables). In the study done by Heshmati Nabavi et al., the questionnaire was validated by 12 specialists and instructors of continuing professional development (CPD) at Tarbiat Modarres University, Tehran, and Mashhad University of Medical Sciences by the Content Validity Index (CVI) method. For its reliability confirmation, the internal consistency assessment method and Cronbach's alpha estimation were utilized, and its reliability was confirmed with Cronbach's alpha coefficient as 0.76 (7). In the study done by Bagherzadeh et al., the scale’s internal correlation was approved with Cronbach's alpha as 0.92 (6). In a study on working nurses, the internal consistency of the scale was confirmed with a Cronbach's alpha of 0.928, and using the split-half method, it was calculated to be 0.854 for the first half and 0.923 for the second half, indicating very good reliability for the scale. (1). Also, in the present study and two other studies, the internal correlation of the scale was confirmed with Cronbach's alpha of 0.93, which indicates the high internal consistency of the scale used for both nursing students and working nurses. (4, 7). Data analysis was performed when the data got included into SPSS-22 and normality was tested via the Kolmogorov-Smirnov test, and then descriptive statistics indicators and parametric tests such as Pearson correlation coefficient (examining the correlation between two quantitative variables), t-test (comparing the mean scores of the questionnaire in two groups), ANOVA (comparing the mean scores of the questionnaire in more than two groups), and multiple linear regression (identifying the factors affecting the score of professional behavior or that of cognitive dissonance ) were taken into account. In all cases of statistical analysis, the level of significance less than or equal to 0.05 (P ≤ 0.05) was considered. The present study was approved by the Ethics Committee of Mazandaran University of Medical Sciences (IR.MAZUMS.REC.1403.208). Ethical considerations including to gain informed consent from the individuals to participate in the research and to guarantee the confidentiality of the results were observed in the research. Findings The current study consisted of totally 235 participating nurses working in the wards of Bu-Ali Sina, Imam Khomeini, Fateme Zahra and Za’re teaching hospitals. In accordance with the results, the mean and standard deviation of the participants’ age was 32.90 ± 7.74 in the age range (22-55) and the majority of them (80.9%) were women, 58.3% were married and 87.7% of the nurses had a BSc. Most of the participants (88.9%) were city dwellers and a small number of them (19.6%) had a second job. The mean and standard deviation of the participating nurses’ work history was 8.43 ± 7.46 and the mean number of patients per shift was 12.61 ± 9.12. Around half of the nurses (49.8%) were of registered employment, (82.6%) had rotating shifts, (55.3%) worked in general wards and (40.4%) in specialized wards (dialysis, CCU, ICU). The mean overtime working hours of the nurses was 50.33 ± 20.56, and they reported their level of interest in nursing from one to ten as 5.76 ± 2.80, and a few of them (20.4%) were dissatisfied with the department where they worked with. About 7.7% of the nurses were suffering from a psychiatric disease, and around 3.4% were taking psychiatric medication. Moreover, 59.1% of the nurses experienced stressful events in the past 6 months. Most of the nurses (68.5%) did not pass communication skills training courses. Table 1 depicts comparing the mean scores of professional behavior and cognitive dissonance of nurses according to demographic variables. Table 1: Comparison of professional behavior and cognitive dissonance scores of nurses in terms of demographic variables Variable Professional behavior Cognitive dissonance Mean SD Mean SD Gender Woman 110.32 13.92 82.92 9.26 Man 107.53 16.96 86.78 9.51 t-statistic 1.156 2.937 P-value 0.249 0.004 Marital status Single 108.92 15.87 83.48 9.78 Divorced /Widow /widower 108.11 13.04 82.21 9.81 Married 110.52 14.01 83.03 9.27 F statistic 0.44 0.15 P-value 0.647 0.860 Academic degree BSc 109.69 14.46 83.22 9.11 MSc 110.45 15.50 82.34 11.77 t-statistic 0.261 0.468 P-value 0.795 0.640 Second job Yes 105.76 15.42 81.83 11.10 No 110.77 14.21 83.43 9.02 t-statistic 2.107 1.031 P-value 0.036 0.304 Job Commitment status Planned forces/ plan extension 108.60 16.77 83.15 8.61 Registered 110.68 13.71 83.55 92.22 Temporary 106.68 15.19 78.86 12.30 Contractual 106.60 11.37 85.40 8.62 Corporate 112.75 11.51 84.17 10.03 F statistic 0.874 1.279 P-value 0.480 0.279 Type of ward Emergency 111.40 9.72 81.80 9 Specialized wards(Dialysis, CCU, ICU) 110.79 13.94 83.06 9.66 General 108.93 15.31 83.25 9.40 F statistic 0.509 0.111 P-value 0.602 0.895 Work shift Fixed morning shift 110.92 9.90 87.69 7.83 Fixed afternoon shift 118.92 12.71 91.58 12.94 Fixed night shift 110.31 13.42 80.19 6.44 Rotating shift 109.10 14.89 82.53 9.22 F statistic 1.767 5.258 p-value 0.154 0.002 Ward-related satisfaction Yes 110.37 14.40 83.80 9.29 No 107.50 15.09 80.44 9.73 t-statistic 1.221 2.217 p-value 0.223 0.028 Suffering from a psychiatric illness Yes 113.33 9.68 77.39 10.49 No 109.49 14.87 83.59 9.23 t-statistic 1.076 2.710 p-value 0.283 0.007 Taking psychiatric medication Yes 117 11.83 74.50 11.25 No 109.53 14.60 83.42 9.27 t-statistic 1.429 0.154 p-value 2.656 0.008 Experiencing stressful events in the past 6 months Yes 108.96 14.62 82.21 8.64 No 110.99 14.45 84.43 10.44 t-statistic 1.053 1.776 p-value 0.294 0.077 As exposed by the results of the independent t-test and ANOVA, a tangible relationship was observed between professional behavior and having a second job (P<0.05), so that the mean score of professional behavior was higher in those not having a second job. A meaningful relationship popped up between cognitive dissonance and gender, work shift, and satisfaction with the department (P<0.05), so that the mean score of cognitive dissonance was higher in men, the personnel working in fixed night shift, and the nurses who were satisfied with the department where they worked in (they reduced their dissonance more). Table 2: Correlation between scores of the Nurses' Professional Behavior and DARQ and quantitative demographic variables Variable Professional behavior DARQ Correlation coefficient p-value Correlation coefficient p-value Age 0.085 0.192 0.167 0.010 Work history (years) 0.105 0.108 0.169 0.009 Average weekly work hours 0.039 0.556 -0.010 0.882 Average number of patients per shift 0.150 0.025 0.087 0.196 Average overtime hours -0.183 0.005 -0.058 0.385 Level of interest in the nursing profession (Score from 1 to 10) 0.217 0.001 0.196 0.003 Table 2 illustrates the correlation between the scores of professional behavior and DAR of the nurses using quantitative variables. As indicated by the results, the professional behavior score has a direct critical relationship with the average number of patients per shift and the level of interest in nursing. The DARQ score also has a direct significant relationship with work history and the level of interest in nursing, that is, the experienced nurses and the nurses more interested in their profession also had higher cognitive dissonance. Table 3: Correlation between questionnaire scores of professional behavior and DAR and its dimensions in nurses Variable Professional behavior Cognitive dissonance (Total) Arousal Dissonance reduction Correlation coefficient p-value Correlation coefficient p-value Correlation coefficient p-value Correlation coefficient p-value Professional behavior 1 - 0.256 0.000 0.226 0.000 0.148 0.023 Cognitive dissonance 0.256 0.000 1 - 0.763 0.000 0.709 0.000 Arousal 0.226 0.000 0.763 0.000 1 - 0.084 0.198 Dissonance reduction 0.148 0.023 0.709 0.000 0.084 0.198 1 - Table 4 : Descriptive data of the professional behavior scale score Variable Professional behavior Mean± SD 109.79±14.55 levels No(%) Low (scores 63 and lower) 0(0) Moderate (scores 64-100) 55(23.4) High (scores 101-135) 180(76.6) Total 235(100) Table 5: Descriptive data of the Dissonance Arousal and Reduction Questionnaire (DARQ) score Variable Mean± SD Dissonance Arousal and Reduction dissonance Total 83.11±9.45 Arousal 39.16±6.7 Dissonance reduction 43.96±6.14 Levels No (%) Low (scores 63 and lower) 0(0) Moderate (scores 64-100) 55(23.4) High (scores 101-135) 180(76.6) Total 235(100) The mean and standard deviation of the total score of the professional behavior scale and DARQ in the study participating nurses were 109.79 ± 14.55 and 83.11 ± 9.45, respectively. The results displayed the professional behavior of most nurses (76.6%) as high, and the cognitive dissonance score of most nurses (95.7%) in the range of dissonance reduction, indicating that most nurses can reduce their arousal. The results of the Pearson correlation test reported a direct meaningful association between professional behavior and cognitive dissonance (P = 0.00, r = 0.256). Since a higher score in the DARQ means better dissonance reduction and arousal, or in other words, an increase in consonance, it can be interpreted that an increase in cognitive consonance, professional behavior occurs at a higher level. Multiple linear regression was employed to determine the factors influencing professional behavior. Pursuant to the results, the professional behavior score had a direct tangible relationship with the average number of patients and the level of interest in nursing, and an inverse significant relationship with the rate of overtime hours. The professional behavior score was also higher in those taking psychiatric medications (P<0.05). Other demographic variables were not meaningfully associated with professional behavior (P<0.05). Table 6 presents the factors affecting the professional behavior score in the participating nurses. Table 6: Regression coefficient of professional behavior score and research variables Variable Regression coefficient SD CI 95% p-value Upper lower Age -0.23 0.15 0.07 -0.54 0.130 Gender Woman 0 - - - - Man -.3.78 2.49 1.08 -8.66 0.128 Marital status Single 0 - - - - Divorced /widow/widower -3.93 3.72 3.36 -11.23 0.291 Married 0.24 2.18 4.56 -3.98 0.910 Academic degree BSC - - - - - MSc 1.619 3.23 7.96 -4.72 0.619 Second job Yes 0 - - - - No 3.73 2.34 8.29 -0.85 0.110 Job Commitment status Planned forces/ plan extension 0 - - - - Registered -1.09 2.73 6.46 -4.26 0.688 Temporary -3.16 3.81 4.31 -10.64 0.406 Contractual -5.02 6.25 7.23 -17.28 0.422 Corporate 2.30 3.49 9.16 -4.54 0.509 Type of ward Emergency - - - - - Specialized wards(Dialysis, CCU, ICU) 9.89 5.63 20.93 -1.14 0.079 General 0.38 5.04 10.27 -9.51 0.940 The average number of patients 0.58 0.13 0.85 0.32 0.00 The average overtime working hours -0.16 0.05 -0.05 -0.26 0.002 Work shift Fixed morning shift - - - - - Fixed afternoon shift 8.82 5.41 19.41 -1.77 0.103 Fixed night shift 4.33 5.03 14.19 -5.52 0.389 Rotating shift -0.43 3.90 8.29 -6.92 0.860 Ward-related satisfaction Yes 0 - - - - No -0.429 2.29 4.09 -4.88 0.851 Suffering from a psychiatric illness Yes 0 - - - - No -3.13 4.33 5.36 -11.62 0.470 Taking psychiatric medications Yes 0 - - - - No -16.76 6.44 -4.12 -29.39 0.009 Experiencing a stressful event Yes 0 - - - - No 1.25 1.89 4.95 -2.44 0.506 Level of interest in nursing profession(Score from 1 to 10) 0.78 0.33 1.43 0.12 0.020 Cognitive dissonance 0.37 0.10 0.58 0.17 0.000 Discussion The current study was designed and performed targeting to outline the relationship between professional behavior and cognitive dissonance among the nurses working in teaching hospitals affiliated with Mazandaran University of Medical Sciences. The results demonstrated76.6% of the nurses with high levels of professional behavior, and the mean and standard deviation of the professional behavior score as 109.79 ± 14.55. In this respect, the research of Khajavi et al. (2019), titled Relationship between Ethical Intelligence and Professional Behavior in Nurses, also reported the professional behavior score as 113.33 ± 13.66 ( 1 ), which can be interpreted that the nurses working in teaching hospitals of Mazandaran University of Medical Sciences have high levels of professional behavior. Moreover, the study done by Khachian et al. (2015) with the title Evaluation Nurses’ Professional Behavior and its Relationship with Organizational Culture and Commitment reported a high level of professional behavior score as 107.98 ± 17.41 among nurses ( 30 ). Jahanbazi et al. (2019) in their study called Investigation Relationship between Professional Behavior and Job Well- Being among Nurses in Shahrekord-based Educational Hospitals reported the professional behavior score as 104.5 ± 17.8 ( 5 ). Also, the studies of Heshmati-Nabavi et al. (2014) in Mashhad and Mousaviasl et al. (2019) in Abadan titled Comparison of Nursing Students’ Professional Behavior to Nurses Employed in Mashhad University of Medical Sciences and Comparison between Professional Behavior of Nursing Students and Employed Nurses reported professional behavior scores of employed nurses as 109 ± 12.6 and 112.48 ± 13.01, respectively ( 4 , 7 ). These close numerical values may indicate an identical status of professional behavior in the study population. Around 95.7% of the present study nurses scored in the range of dissonance reduction. The mean and standard deviation of the cognitive dissonance score of the study participating nurses was 83.11 ± 9.45. Since no study in Iran directly reported this mean score among the nurses, it is not possible to make a numerical comparison with the previous studies. This could imply research gap in this area and the requirement for further investigation of this variable in different nursing populations. Moreover, the present study extracted results revealed a direct meaningful relationship between the scores of professional behavior and the cognitive dissonance (P = 0.00, r = 0.256). Since achieving a higher score in the DARQ means a better reduction of dissonance and arousal, or in other words, consonance increase, it can be interpreted that an increase in cognitive consonance leads to professional behavior at a higher level. Regarding lack of studies in this area, it was not viable to compare the relationship between professional behavior and cognitive dissonance in other nursing populations. The present study divulged a significant association between professional behavior and the variables: the average number of patients, the level of interest in nursing, taking psychiatric medication, and overtime working hours. Aiken et al. (2002) addressed hospital nursing staff deficiency and patient mortality, nurse burnout, and job dissatisfaction. They stated that as the number of patients under care gets more, patient mortality, nurse burnout, and job dissatisfaction increases ( 31 ). Hayter et al. (2013) in their research as Key Messages for Nursing also reported that the more standardized the nurse-patient ratio and the more skilled the nurses, the higher the quality of care provision ( 10 ). As reported by the current research, a direct significant relationship was observed between the number of patients and the professional behavior score of nurses, the finding which is somewhat contradictory to previous studies. Although it can be claimed that the staff with a higher number of patients per shift acquire certain skills compared to other nurses, which might be effective in the occurrence of professional behavior. On the other hand, it is probable that such nurses have reported high professional behavior due to occupational or environmental reasons and using self-report questionnaires, which partially justifies this relationship. Dyrbye et al. (2020) in their research as Relationship between Burnout and Professional Behaviors and Beliefs among US Nurses found an inverse significant relationship between burnout and professional behavior ( 32 ). Besides, as displayed by the study of Stelnicki et al. (2021), titled Associations between Burnout and Mental Disorder Symptoms among Nurses in Canada, a direct meaningful relationship was discovered between burnout and the outbreak of psychiatric disorders ( 33 ). Considering such cases, it can be indirectly concluded that the prevalence of psychiatric disorders may be associated with declined professional behavior. In the current study, no significant relationship popped up between the professional behavior score and the outbreak of psychiatric illness, while the professional behavior score of the nurses taking psychiatric medication was tangibly higher than those not doing so. The contrast observed in the present study is likely due to the effective treatment and promoted psychological and social functioning of such individuals with diagnosed disorders compared to other populations. It is recommended to conduced further investigation on this issue in future studies. In the study performed by Bagherzadeh (2021), called Predicting Role of Safety Climate in Professional Behavior of Nurses, the average level of interest in nursing was reported as 7.51 ± 2.27 on the scale 1–10, and the mean score of professional behavior among the nurses rating their interest in nursing higher was critically more ( 6 ). This is also true in the research of Heshmati-Nabavi et al. ( 7 ). In the present study, the mean and standard deviation of the score of interest in nursing was reported as 5.76 ± 2.80 from 1 to 10 by the nurses, and there was a positive significant relationship between the level of interest in nursing and the score of professional behavior. Watanabe and Yamauchi (2018) in their study, known as Effect of Quality of Overtime Work on Nurses' Mental Health and Work Engagement, indicated the negative effect of imposed overtime on nurses' mental health and job engagement ( 34 ). The current research also reported professional behavior drop as the hours of overtime work increase, the finding which can be indirectly congruent with their study drawn results. In this study, professional behavior did not expose a significant relationship with age, gender, marital status, academic degree, job commitment status, work experience, the type of work shift, and the history of stressful events in the past 6 months. As reported by the study done by Khajavi et al. (2020), no critical relationship was spotted between professional behavior and the variables of age, academic degree, job commitment status, work experience, work shift, and the history of stressful events, but gender (women) and marital status (being single, widow or widower) are the important predictors of professional behavior ( 1 ). The study done by Jahanbazi and lotfizadeh (2019), as Investigation Relationship between Professional Behavior and Job Well- Being among Nurses in Shahrekord's Educational Hospitals, revealed an inverse tangible relationship between age and professional behavior, and the professional behavior score was significantly higher in women than in men and in the nurses with a bachelor's degree than in other academic degrees (associate or master's degree) ( 5 ). Yet, the study of Hisar et al. (2010), tiled Determining Professional Behavior of Nursing Executive, and that of Konukbay et al. (2014), known as Determining Professional Behaviors of Nurses Working in an Educational and Research Hospital, reported a significant relationship and increased mean score of professional behavior by higher academic degree ( 35 , 36 ). Differences in demographics, cultural, environmental, research method, and working conditions may be the factors contributing to this discrepancy. Earlier in this study, no major relationship was reported between the scores of professional behavior and work experience. Consistent with the present study, the research performed by Heshmati-Nabavi et al. (2014) indicated no meaningful relationship between professional behavior and work experience ( 7 ), while the study by Tanaka et al. (2016), called Professional Behaviors and Factors Contributing to Nursing Professionalism among Nurse Managers, reported that the more the history of working years, the higher the professional behavior gets promoted ( 37 ). This discrepancy may be under the influence of various work environments. Additionally, the current study reported no tangible association between the score of professional behavior and the type of ward and work shift. Unlike this, in the research of Dinç and Yıldız (2023), on Evaluation of Relationship between Job Satisfaction and Professional Behavior in Pediatric Nurses, a statistically meaningful difference was reported between the mean scores of professional behavior of nurses considering the type of ward. Moreover, their study showed the score of professional behavior of morning shift nurses as significantly higher than that of night or rotating shift working nurses ( 38 ). It is worth mentioning that the results of the study performed by Ruiz-Fernández et al. (2020), on Quality of Life in Nursing Professionals Nurses: Job Burnout, Fatigue, and Satisfaction, reported lower burnout in the morning shift than in other work shifts ( 39 ). Since increased burnout has a negative effect on the level of professional behavior ( 32 ), it can be concluded that the type of work shift may indirectly affect professional behavior. In addition to the above stated findings of the current study, there was no significant relationship between the score of professional behavior and satisfaction with the ward. The results of the study by Jahanbazi et al. (2019) demonstrated professional behavior and job well-being having a significant positive relationship ( 5 ). Regarding that satisfaction with the workplace is one of the dimensions of job well-being, the findings of the current study may indirectly contradict those reported by the study of Jahanbazi et al. (2019). Considering the questionnaires being of self-report nature, one of the study limitations is the likelihood of bias and lack of precise responses by the staff due to job considerations or the concerns about incorrect judgment. Also, the current study was carried out in only one geographical area, so it is not possible to generalize the results to the entire nursing community. Moreover, the limited research related to the cognitive dissonance variable has made it tough to analyze and compare the results. Declarations Author Contribution Maryam Asri worked on the data collection and writing the first draft of the articleA. Hossein-Nataj performed the data analysis and interpreted the results. V. Shafipour was the advisor of the article.H.Azimi lolaty designed and supervised the workAlso All authors reviewed the manuscript. Acknowledgement The authors would like to sincerely appreciate the Deputy of Research and Technology of Mazandaran University of Medical Sciences, the Executive of Sari-based Teaching Hospitals, and all nurses lending us a hand in conducting this research. References Khajavi Z, Vaezzadeh N, Mousavinasab SN, Azimi Lolaty H. Relationship between Ethical Intelligence and Professional Behavior in Nurses. J Mazandaran Univ Med Sci. 2020;30(185):86–95. Khachian A, Ashghali Farahani M, Haghani H, Ahmadi Tameh M. Evaluation nurses' professional behavior and its relationship with organizational culture and commitment in 2015. Int J Med Res Health Sci. 2016;2(12):247–52. Jabari F, Ooshaksaraie M, Azadehdel M, Mehrabian F. Relationship between patient safety culture and professional conduct of nurses in context of clinical governance implementation. J title. 2015;25(3):27–33. Mousaviasl S, Elhami S, Ban M, Zahedi A, Arizavi Z. Comparison between the professional behavior of nursing students and employed nurses. J Advanc Pharm Educ Res| Apr-Jun. 2019;9(S2):173–5. Jahanbazi r, lotfizadeh m. Investigation the Relationship between Professional Behavior and Job Well- Being among Nurses in Shahrekord's Educational Hospitals. Hospital. 2019;18(1):43–53. Bagherzadeh R, Salemipoor Y, Hajinejad F, Heidari F, Vahedparast H. The Predicting Role of the Safety Climate in the Professional Behavior of Nurses: A Cross-Sectional Study2021. Heshmati Nabavi F, Rajabpour M, Hoseinpour Z, Hemmati maslakpak M, Hajiabadi F, mazlom sr, et al. Comparison of Nursing Students’ Professional Behavior to Nurses Employed in Mashhad University of Medical Sciences. Iran J Med Educ. 2014;13(10):809–19. Fattahi Bafghi A, Barkhordari Sharifabad M. The Relationship between Clinical belongingness and Professional Behavior in Nursing Students. J Med Edu Dev. 2020;15(3):182–93. de Vries J, Timmins F. Care erosion in hospitals: problems in reflective nursing practice and the role of cognitive dissonance. Nurse Educ Today. 2016;38:5–8. Hayter M. The UK Francis Report: the key messages for nursing. J Adv Nurs. 2013;69(8):e1–3. Harvey C, Thompson S, Otis E, Willis E. Nurses’ views on workload, care rationing and work environments. J Nurs Adm Manag. 2020;28(4):912–8. Fontenot HB, Hawkins JW, Weiss JA. Cognitive dissonance experienced by nurse practitioner faculty. J Am Acad Nurse Pract. 2012;24(8):506–13. Aghayousefi A, Zare M, Zare H, Shaghaghi F, Eftekhari M. Evaluation of role of personality (behavioral systems) in cognitive dissonance and related physiological components. Health Psychol. 2016;5(18):52–68. Yaghubi H, Mousavi A. Effect of Group Cognitive-Behavioral Training on Reducing Cognitive Dissonance and Increasing Self-esteem in Middle-aged Women. Eur Acad Res. 2014;4(2). Bice AA. Cognitive dissonance and pediatric procedural pain management: A concept clarification. Pain Manage Nurs. 2018;19(3):230–7. Braun LT, Schmidmaier R. Dealing with cognitive dissonance: an approach. Med Educ. 2019(12):1167–8. Sepehr RM, Bagherian F, Heidari M, editors. Cognitive dissonance and attitude change: role of various standards interacting with self-esteem, 2011. Seyedeh H, Ghorbani E. The Relationship between Arousal and Cognitive Dissonance Reduction with Mental Health of Urmia University Students. Dinarvand N, Barghi Irani Z. The Comparison of the Effectiveness of Metacognitive Therapy and Spiritual Therapy on Cognitive Dissonance and Feeling Loneliness in the Elderly living in Nursing Homes. Aging Psychol. 2021;7(2):197–81. Randall HM. Cognitive Resonance: The Hidden Geometry of Thought, 2025. Available from: https://medium.com/the-empathic-technologist/cognitive-resonance-the-hidden-geometry-of-thought-c80f56737929 Golparvar M, Javadian Z, Barazandeh A. The role of cognitive Resonance in the link between ethical leadership and teachers' job satisfaction. 2012. Naami Z, Rezayatizadeh A. The Effectiveness of Lazarus Multimodal Therapy on Cognitive Dissonance and Sexual Satisfaction in Women with Ambivalent Attachment Style. Community Health J. 2022;16(1):76–86. Harmon-Jones E, Harmon-Jones C. Cognitive Dissonance Theory After 50 Years of Development. Z Fur Sozialpsychologie -Z sozpsychol. 2007;38:7–16. Harmon-Jones E, Peterson H, Vaughn K. The Dissonance-Inducing Effects of an Inconsistency Between Experienced Empathy and Knowledge of Past Failures to Help: Support for the Action-Based Model of Dissonance. Basic and Applied Social Psychology -Basic appl soc psychol. 2003;25:69–78. Marie-A M, Milland L, Olive T. Some Theoretical Considerations on Attitude, Arousal and Affect during Cognitive Dissonance. Soc Pers Psychol Compass. 2013;7:680–8. Smith J. Cognitive dissonance and the overtaking anomaly: Psychology in the principal–agent relationship. J Socio-Econ. 2009;38(4):684–90. Mortensen AH, Stojiljkovic M, Lillekroken D. Strategies to manage cognitive dissonance when experiencing resistiveness to care in people living with dementia: A qualitative study. J Adv Nurs. 2022;78(2):486–97. Klein J, McColl G. Cognitive dissonance: how self-protective distortions can undermine clinical judgement. Med Educ. 2019;53(12):1178–86. Saffarinia M, Zandi A. Standardization of Dissonance Arousal and Reduction Questionnaire (DARQ) in students of Payam Noor University in Tehran 2010. Khachian A, Ashghali Farahani M, Haghani H, Ahmadi Tameh M. Evaluation nurses’ professional behavior and its relationship with organizational culture and commitment in 2015. Int J Med Res Health Sci. 2016;5(12):247–52. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987–93. Dyrbye LN, West CP, Hunderfund AL, Johnson P, Cipriano P, Peterson C, et al. Relationship between burnout and professional behaviors and beliefs among US nurses. J Occup Environ Med. 2020;62(11):959–64. Stelnicki AM, Jamshidi L, Angehrn A, Hadjistavropoulos HD, Carleton RN. Associations between burnout and mental disorder symptoms among nurses in Canada. Can J Nurs Res. 2021;53(3):254–63. Watanabe M, Yamauchi K. The effect of quality of overtime work on nurses' mental health and work engagement. J Nurs Manag. 2018;26(6):679–88. Hisar F, Karadağ A. Determining the professional behaviour of nurse executives. Int J Nurs Pract. 2010;16(4):335–41. Konukbay D, Yildiz D, Fidanci BE, Yavuz S, Akbayrak N. Determination of professional behaviours of nurses working in an educational and research hospital. Int J Caring Sci. 2014;7(2):633–41. Tanaka M, Taketomi K, Yonemitsu Y, Kawamoto R. Professional behaviours and factors contributing to nursing professionalism among nurse managers. J Nurs Adm Manag. 2016;24(1):12–20. Dinç F, Yıldız D. Evaluation of the relationship between job satisfaction and professional behaviors in pediatric nurse. Eur J Clin Experimental Med. 2023(3):553–60. Ruiz-Fernández MD, Pérez-García E, Ortega-Galán ÁM. Quality of life in nursing professionals: Burnout, fatigue, and compassion satisfaction. Int J Environ Res Public Health. 2020;17(4):1253. Stern DT, Frohna AZ, Gruppen LD. The prediction of professional behaviour. Med Educ. 2005;39(1):75–82. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Professional behavior involves the provision of nursing care based on values and norms appropriate to the profession. Such care is compatible with specific behavioral standards realized through the acquisition of knowledge, attitudes, and skills, leading to commitment to the profession and enhanced nursing performance (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Novice nurses learn professional behavior in various ways, mainly by observing how others behave (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Numerous reports display unprofessional and unethical behavior occurring in different departments of university hospitals (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Patients\u0026rsquo; physical and mental health is directly linked with the quality of nurses' performance and professional behavior, so it is highly critical to focus on cultivating and promoting professional behavior in nurses. Besides, promoting professional behavior in nurses leads to increasing the quality of service provision by nurses and patient satisfaction, upgrading the productivity of health centers, lifting job satisfaction and motivation, and decreasing their physical and mental fatigue (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The studies done in Iran reported the rate of professional behavior based on Goz Nursing Students Professional Behavior Scale (NSPBS) as 104\u0026ndash;113, which is considered high (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Professional behavior and the quality of care provided by nurses are associated with many factors (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). What is vividly grasped from the reports is that if the decline in the quality of care occurs gradually, it usually does not provoke a reaction from the managers of health centers; this gradual reduction in the quality of care and not paying attention to it causes gradual increase in the violations of standards, declining performance, and ultimately, providing faulty care to patients (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In most cases, deficient care provision is not due to low level skills in nurses or lack of compassion and empathy in them; rather, it is because they are trying to provide service to a large number of patients and are simultaneously under pressure due to responding to the demands of managers, the deprivation of resources, and excessive stress (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn some cases, hospital policy and management paves a ground that ultimately forces staff to do things in contrast to their judgment and beliefs (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Under such circumstances, the personnel\u0026rsquo;s attitudes, beliefs, and behaviors may conflict with each other (\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Cognitive dissonance is defined as a mental phenomenon in which individuals unknowingly hold fundamentally conflicting cognitions. As proposed by Leon Festinger, human beings always strive for intern psychological consistency to maintain coherence and harmony between their attitudes, cognitions, and values, and the existence of some kind of incoherence and inconsistency between them creates a disturbing state referred to dissonance (\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). This reconciliation in the brain's cognitive processes is required for basic mental functions such as problem solving, decision-making, and interactions (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), and it also leads to peace and comfort (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Conversely, the more dissonance there is, the more unpleasant emotions are experienced, which may affect one\u0026rsquo;s memory, attention, or problem-solving and decision-making potentials (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eVarious studies revealed the occurrence of dissonance being correlated with various factors such as interpersonal interaction, mental structure, self-esteem, personality traits, the presence of a source of control, and a positive self-concept (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Dissonance can manifest itself in the form of guilt, shame, stress, regret, or anger, which subsequently brings about psychophysiological consequences like increased heart rate, higher blood pressure, and impaired decision-making and learning processes. The outbreak of such a negative feeling in an individual motivates them to take measures to modify the situation and reduce dissonance (\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The approach an individual adopts to lower dissonance leads to positive or negative performance (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Individuals may apply various short or long term strategies for dissonance reduction: Denial, trivializing dissonant cognition, creating new consonant cognition, providing justifications to defend oneself, changing one's attitude, or blaming others are examples of such strategies (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Despite the importance of this issue, no study has been performed to outline the relationship between professional behavior and cognitive dissonance; thus, the current research was done to find out the association between professional behavior and cognitive dissonance among the nurses working in university hospitals of Mazandaran University of Medical Sciences in 2024.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003eThis descriptive-analytical correlational study was conducted at Mazandaran University of Medical Sciences in 2024. This study sample size was calculated using the research of Khajavi et al., in which the mean of professional behavior was reported as 113.33 ± 13.66 (1). Considering Type I error of 5% and the power of test (1- β) of 80%, the measurement error (d) of 2.5 units is given by the following formula:\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\" width=\"613\" height=\"73\"\u003e\u003c/p\u003e\n\u003cp\u003eSince the current study was a cross-sectional study, sample attrition was not taken into account and totally, 235 samples were calculated. Then, sampling was done as Stratified random sampling . For this purpose, after calculating the statistics on the total number of nursing staff working in the the teaching hospitals of Mazandaran University of Medical Sciences in Sari, each hospital was viewed as a strata \u0026nbsp;and the required sample was estimated in each hospital. To access the samples in each hospital, based on the total list of nurses in each hospital, the required number of samples was chosen and the wards where the selected nurses worked were visited. Observing the inclusion and exclusion criteria, ethical considerations and filling out the informed consent, the questionnaire was distributed among them and completed. The study inclusion criteria were having at least 6 months of continuous work experience in the question hospital and having a bachelor's or higher degree in nursing, and the exclusion criteria included reluctant to cooperate and being in the position as a nursing manager (like head nurses, matrons, supervisors). To do this study, a demographic checklist (the results of which are given in Table 1), the Harmon-Jones Dissonance Arousal and Reduction Questionnaire, and Nursing Students’ Professional Behavior Scale were utilized.\u003c/p\u003e\n\u003cp\u003e1.\u003cstrong\u003eHarmon-Jones Dissonance Arousal and Reduction Questionnaire (DARQ):\u003c/strong\u003e This questionnaire was developed by Harmon-Jones et al. (2008) pursuing Leon Festinger's Theory of Cognitive Dissonance made up of 25 items and 2 subscales: arousal (12 items) and dissonance reduction (13 items). The questionnaire is scored on a Likert scale, with scores of 1, 2, 3, 4, and 5 for the options \"Never,\" \"Rarely,\" \"Sometimes,\" \"Often,\" and \"Always,\" respectively. The items on the arousal subscale are reversely scored. To gain the questionnaire’s total score, the scores of all items are added together. The min and max scores from this questionnaire are 25 and 125, respectively. Scores less than 36 stand for excessive arousal and increased dissonance. In fact, those whose total scores are less than 36 are unable to reduce negative dissonance-induced feelings. Scores greater than 66 indicate excessive reduction of arousal and dissonance, which means the individuals whose total scores are greater than 66 reduce their arousal in dissonance-provoking situations (29). Since dissonance reduction means creating harmonious internal state, it can be stated that getting a high score on the \u0026nbsp;DARQ actually signals the potential for harmony buildup (dissonance reduction). Saffarinia and Zandi (2010) \u0026nbsp;administered the questionnaire to 528 students at Payam-e-Noor University in Tehran to test the questionnaire’s psychometric properties in Iran population. The internal correlation of the items displayed three items having a negative or poor correlation with the rest of the questionnaire items. Thus, they were removed and the number of items reduced to 25 from 28. In the study drawn results, the Cronbach's alpha coefficient was 0.827, and the reliability coefficient of the Dissonance Arousal and Reduction subscales was reported by Cronbach's alpha method as 0.74 and 0.84, respectively. (29). In this study, the reliability coefficient of the DARQ’s subscales reported by Cronbach's alpha was 0.83 and 0.76, respectively. Besides, the Cronbach's alpha for the whole questionnaire was 0.79, which indicates the scale’s reliability as appropriate in measuring the desired variable.\u003c/p\u003e\n\u003cp\u003e2. \u003cstrong\u003eNursing Students’\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Professional Behavior Scale (NSPBS)\u003c/strong\u003e The \u003cstrong\u003eNSPBS\u003c/strong\u003e developed by Goz et al.: This scale is a modified version of the Goz and Geckil’s Nursing Students Professional Behavior Scale (NSPBS), which was employed in Iran and also in our research in order to measure the nurses' professional behavior. The 27-item scale in the form of a Likert scale including 5 options: \"Always\", \"Often\", \"No opinion\", \"Sometimes\" and \"Not at all\", each of which is scored 5, 4, 3, 2 and 1, respectively. The scores gained from this scale are 27 and 135 as the min and max values, and scores 27-63 are considered low, scores 64-100 moderate and scores 101-135 higher, professional behavior (5). This questionnaire does not have components (dimensions or sub-variables). In the study done by Heshmati Nabavi et al., the questionnaire was validated by 12 specialists and instructors of continuing professional development (CPD) at Tarbiat\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u0026nbsp;\u003c/span\u003eModarres University, Tehran, and Mashhad University of Medical Sciences by the Content Validity Index (CVI) method. For its reliability confirmation, the internal consistency assessment method and Cronbach's alpha estimation were utilized, and its reliability was confirmed with Cronbach's alpha coefficient as 0.76 (7). In the study done by\u0026nbsp;Bagherzadeh\u0026nbsp;et al., the scale’s internal correlation was approved with Cronbach's alpha as 0.92 (6). In a study on working nurses, the internal consistency of the scale was confirmed with a Cronbach's alpha of 0.928, and using the split-half method, it was calculated to be 0.854 for the first half and 0.923 for the second half, indicating very good reliability for the scale. (1).\u003c/p\u003e\n\u003cp\u003eAlso, in the present study and two other studies, the internal correlation of the scale was confirmed with Cronbach's alpha of 0.93, which indicates the high internal consistency of the scale used for both nursing students and working nurses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(4, 7).\u003c/p\u003e\n\u003cp\u003eData analysis was performed when the data got included into SPSS-22 and normality was tested via the Kolmogorov-Smirnov test, and then descriptive statistics indicators and parametric tests such as Pearson correlation coefficient (examining the correlation between two quantitative variables), t-test (comparing the mean scores of the questionnaire in two groups), ANOVA (comparing the mean scores of the questionnaire in more than two groups), and multiple linear regression (identifying the factors affecting the score of professional behavior or that of cognitive dissonance ) were taken into account. In all cases of statistical analysis, the level of significance less than or equal to 0.05 (P ≤ 0.05) was considered.\u003c/p\u003e\n\u003cp\u003eThe present study was approved by the Ethics Committee of Mazandaran University of Medical Sciences (IR.MAZUMS.REC.1403.208). Ethical considerations including to gain informed consent from the individuals to participate in the research and to guarantee the confidentiality of the results were observed in the research.\u003c/p\u003e\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n"},{"header":"Findings","content":"\u003cp\u003eThe current study consisted of totally 235 participating nurses working in the wards of Bu-Ali Sina, Imam Khomeini, Fateme Zahra and Za’re teaching hospitals. In accordance with the results, the mean and standard deviation of the participants’ age was 32.90 ± 7.74 in the age range (22-55) and the majority of them (80.9%) were women, 58.3% were married and 87.7% of the nurses had a BSc. Most of the participants (88.9%) were city dwellers and a small number of them (19.6%) had a second job. The mean and standard deviation of the participating nurses’ work history was 8.43 ± 7.46 and the mean number of patients per shift was 12.61 ± 9.12. Around half of the nurses (49.8%) were of registered employment, (82.6%) had rotating shifts, (55.3%) worked in general wards and (40.4%) in specialized wards (dialysis, CCU, ICU). The mean overtime working hours of the nurses was 50.33 ± 20.56, and they reported their level of interest in nursing from one to ten as 5.76 ± 2.80, and a few of them (20.4%) were dissatisfied with the department where they worked with. About 7.7% of the nurses were suffering from a psychiatric disease, and around 3.4% were taking psychiatric medication. Moreover, 59.1% of the nurses experienced stressful events in the past 6 months. Most of the nurses (68.5%) did not pass communication skills training courses. Table 1 depicts comparing the mean scores of professional behavior and cognitive dissonance of nurses according to demographic variables.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Comparison of professional behavior and cognitive dissonance scores of nurses in terms of demographic variables\u003c/p\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional behavior\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCognitive dissonance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eWoman\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e110.32\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e13.92\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e82.92\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9.26\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eMan\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e107.53\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e16.96\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e86.78\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9.51\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003et-statistic\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1.156\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e2.937\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eP-value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMarital status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e108.92\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e15.87\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e83.48\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9.78\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eDivorced /Widow /widower\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e108.11\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e13.04\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e82.21\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9.81\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e110.52\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e14.01\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e83.03\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9.27\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eF statistic\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eP-value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.647\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.860\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eAcademic degree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eBSc\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e109.69\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e14.46\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e83.22\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9.11\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eMSc\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e110.45\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e15.50\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e82.34\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e11.77\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003et-statistic\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.261\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.468\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eP-value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.640\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSecond job\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e105.76\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e15.42\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e81.83\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e11.10\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e110.77\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e14.21\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e83.43\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9.02\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003et-statistic\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e2.107\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1.031\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eP-value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.304\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eJob Commitment status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003ePlanned forces/ plan\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eextension\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e108.60\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e16.77\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e83.15\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e8.61\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eRegistered\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e110.68\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e13.71\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e83.55\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e92.22\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eTemporary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e106.68\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e15.19\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e78.86\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e12.30\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eContractual\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e106.60\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e11.37\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e85.40\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e8.62\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eCorporate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e112.75\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e11.51\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e84.17\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e10.03\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eF statistic\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.874\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1.279\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eP-value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.480\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.279\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eType of ward\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eEmergency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e111.40\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e9.72\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e81.80\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eSpecialized wards(Dialysis, CCU, ICU)\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e110.79\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e13.94\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e83.06\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9.66\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eGeneral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e108.93\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e15.31\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e83.25\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9.40\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eF statistic\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.509\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eP-value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.602\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.895\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eWork shift\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eFixed morning shift\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e110.92\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e9.90\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e87.69\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e7.83\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eFixed afternoon shift\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e118.92\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e12.71\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e91.58\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e12.94\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eFixed night shift\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e110.31\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e13.42\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e80.19\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e6.44\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eRotating shift\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e109.10\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e14.89\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e82.53\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9.22\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eF statistic\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1.767\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e5.258\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003ep-value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eWard-related satisfaction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e110.37\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e14.40\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e83.80\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9.29\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e107.50\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e15.09\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e80.44\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9.73\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003et-statistic\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1.221\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e2.217\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003ep-value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eSuffering from a psychiatric illness\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e113.33\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e9.68\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e77.39\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e10.49\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e109.49\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e14.87\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e83.59\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9.23\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003et-statistic\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1.076\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e2.710\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003ep-value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.283\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eTaking psychiatric medication\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e11.83\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e74.50\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e11.25\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e109.53\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e14.60\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e83.42\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9.27\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003et-statistic\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1.429\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003ep-value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e2.656\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eExperiencing stressful events in the past 6 months\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e108.96\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e14.62\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e82.21\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e8.64\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e110.99\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e14.45\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e84.43\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e10.44\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003et-statistic\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1.053\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1.776\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003ep-value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.294\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003cp\u003eAs exposed by the results of the independent t-test and ANOVA, a tangible relationship was observed between professional behavior and having a second job (P\u0026lt;0.05), so that the mean score of professional behavior was higher in those not having a second job. A meaningful relationship popped up between cognitive dissonance and gender, work shift, and satisfaction with the department (P\u0026lt;0.05), so that the mean score of cognitive dissonance was higher in men, the personnel working in fixed night shift, and the nurses who were satisfied with the department where they worked in (they reduced their dissonance more).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Correlation between scores of the Nurses' Professional Behavior and DARQ and quantitative demographic variables\u003c/p\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 249px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional behavior\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 249px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDARQ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation coefficient\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation coefficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eWork history (years)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAverage weekly work hours\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e-0.010\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.882\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAverage number of patients per shift\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.196\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAverage overtime hours\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e-0.183\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e-0.058\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.385\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eLevel of interest in the nursing profession\u003c/p\u003e\n \u003cp\u003e(Score from 1 to 10)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.196\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003cp\u003eTable 2 illustrates the correlation between the scores of professional behavior and DAR\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eof the nurses using quantitative variables. As indicated by the results, the professional behavior score has a direct critical relationship with the average number of patients per shift and the level of interest in nursing. The DARQ score also has a direct significant relationship with work history and the level of interest in nursing, that is, the experienced nurses and the nurses more interested in their profession also had higher cognitive dissonance.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Correlation between questionnaire scores of professional behavior and DAR and its dimensions in nurses\u003c/p\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"701\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional behavior\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCognitive dissonance (Total)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eArousal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDissonance reduction\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation coefficient\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation coefficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation coefficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation coefficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eProfessional behavior\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.148\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eCognitive dissonance\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.763\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.709\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eArousal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.763\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eDissonance reduction\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.148\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.709\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e: Descriptive data of the professional behavior scale score\u0026nbsp;\u003c/p\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 259px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eProfessional behavior\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean± SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e109.79±14.55\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003elevels\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eLow (scores 63 and lower)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eModerate (scores 64-100)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e55(23.4)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eHigh (scores 101-135)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e180(76.6)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e235(100)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003cp\u003e\u003cstrong\u003eTable 5:\u003c/strong\u003e Descriptive data of the Dissonance Arousal and Reduction Questionnaire\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(DARQ) score\u0026nbsp;\u003c/p\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean± SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"9\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDissonance Arousal and Reduction dissonance\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e83.11±9.45\u003c/p\u003e\n \u003c/td\u003e\u003ctd height=\"10\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eArousal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e39.16±6.7\u003c/p\u003e\n \u003c/td\u003e\u003ctd height=\"24\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDissonance reduction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e43.96±6.14\u003c/p\u003e\n \u003c/td\u003e\u003ctd height=\"26\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd height=\"26\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevels No (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eLow (scores 63 and lower)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eModerate (scores 64-100)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e55(23.4)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eHigh (scores 101-135)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e180(76.6)\u003c/p\u003e\n \u003c/td\u003e\u003ctd height=\"48\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e235(100)\u003c/p\u003e\n \u003c/td\u003e\u003ctd height=\"78\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003cp\u003eThe mean and standard deviation of the total score of the professional behavior scale and DARQ in the study participating nurses were 109.79 ± 14.55 and 83.11 ± 9.45, respectively. The results displayed the professional behavior of most nurses (76.6%) as high, and the cognitive dissonance score of most nurses (95.7%) in the range of dissonance reduction, indicating that most nurses can reduce their arousal. The results of the Pearson correlation test reported a direct meaningful association between professional behavior and cognitive dissonance (P = 0.00, r = 0.256). Since a higher score in the \u0026nbsp;DARQ means better dissonance reduction and arousal, or in other words, an increase in consonance, it can be interpreted that an increase in cognitive consonance, professional behavior occurs at a higher level. Multiple linear regression was employed to determine the factors influencing professional behavior. Pursuant to the results, the professional behavior score had a direct tangible relationship with the average number of patients and the level of interest in nursing, and an inverse significant relationship with the rate of overtime hours. The professional behavior score was also higher in those taking psychiatric medications (P\u0026lt;0.05). Other demographic variables were not meaningfully associated with professional behavior (P\u0026lt;0.05). Table 6 presents the factors affecting the professional behavior score in the participating nurses.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 6:\u003c/strong\u003e Regression coefficient of professional behavior score and research variables\u003c/p\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"553\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegression coefficient \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCI 95%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003elower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.23\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.54\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eWoman\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eMan\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-.3.78\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.49\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-8.66\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMarital status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eDivorced /widow/widower\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-3.93\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.72\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e3.36\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-11.23\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.291\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.18\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4.56\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-3.98\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.910\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAcademic degree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eBSC\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eMSc\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.619\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.23\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e7.96\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-4.72\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.619\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eSecond job\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3.73\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.34\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e8.29\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.85\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eJob\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCommitment status\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003ePlanned forces/ plan extension\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eRegistered\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-1.09\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.73\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e6.46\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-4.26\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.688\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eTemporary\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-3.16\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.81\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4.31\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-10.64\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eContractual\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-5.02\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.25\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e7.23\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-17.28\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.422\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCorporate\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2.30\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.49\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e9.16\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-4.54\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.509\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eType of ward\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eEmergency\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eSpecialized wards(Dialysis, CCU, ICU)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e9.89\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.63\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e20.93\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-1.14\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.04\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e10.27\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-9.51\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.940\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eThe average number of patients\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eThe average overtime working hours\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.16\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.26\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eWork shift\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eFixed morning shift\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eFixed afternoon shift\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8.82\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.41\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e19.41\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-1.77\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eFixed night shift\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4.33\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.03\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e14.19\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-5.52\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.389\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eRotating shift\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.43\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.90\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e8.29\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-6.92\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.860\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eWard-related satisfaction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.429\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.29\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4.09\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-4.88\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.851\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eSuffering from a psychiatric illness\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-3.13\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4.33\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e5.36\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-11.62\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.470\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eTaking psychiatric medications\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-16.76\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.44\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-4.12\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-29.39\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eExperiencing a stressful event\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.89\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4.95\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-2.44\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eLevel of interest in nursing profession(Score from 1 to 10)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.43\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eCognitive dissonance\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study was designed and performed targeting to outline the relationship between professional behavior and cognitive dissonance among the nurses working in teaching hospitals affiliated with Mazandaran University of Medical Sciences. The results demonstrated76.6% of the nurses with high levels of professional behavior, and the mean and standard deviation of the professional behavior score as 109.79\u0026thinsp;\u0026plusmn;\u0026thinsp;14.55. In this respect, the research of Khajavi et al. (2019), titled Relationship between Ethical Intelligence and Professional Behavior in Nurses, also reported the professional behavior score as 113.33\u0026thinsp;\u0026plusmn;\u0026thinsp;13.66 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), which can be interpreted that the nurses working in teaching hospitals of Mazandaran University of Medical Sciences have high levels of professional behavior. Moreover, the study done by Khachian et al. (2015) with the title Evaluation Nurses\u0026rsquo; Professional Behavior and its Relationship with Organizational Culture and Commitment reported a high level of professional behavior score as 107.98\u0026thinsp;\u0026plusmn;\u0026thinsp;17.41 among nurses (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Jahanbazi et al. (2019) in their study called Investigation Relationship between Professional Behavior and Job Well- Being among Nurses in Shahrekord-based Educational Hospitals reported the professional behavior score as 104.5\u0026thinsp;\u0026plusmn;\u0026thinsp;17.8 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Also, the studies of Heshmati-Nabavi et al. (2014) in Mashhad and Mousaviasl et al. (2019) in Abadan titled Comparison of Nursing Students\u0026rsquo; Professional Behavior to Nurses Employed in Mashhad University of Medical Sciences and Comparison between Professional Behavior of Nursing Students and Employed Nurses reported professional behavior scores of employed nurses as 109\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6 and 112.48\u0026thinsp;\u0026plusmn;\u0026thinsp;13.01, respectively (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). These close numerical values may indicate an identical status of professional behavior in the study population.\u003c/p\u003e \u003cp\u003eAround 95.7% of the present study nurses scored in the range of dissonance reduction. The mean and standard deviation of the cognitive dissonance score of the study participating nurses was 83.11\u0026thinsp;\u0026plusmn;\u0026thinsp;9.45. Since no study in Iran directly reported this mean score among the nurses, it is not possible to make a numerical comparison with the previous studies. This could imply research gap in this area and the requirement for further investigation of this variable in different nursing populations.\u003c/p\u003e \u003cp\u003eMoreover, the present study extracted results revealed a direct meaningful relationship between the scores of professional behavior and the cognitive dissonance (P\u0026thinsp;=\u0026thinsp;0.00, r\u0026thinsp;=\u0026thinsp;0.256). Since achieving a higher score in the DARQ means a better reduction of dissonance and arousal, or in other words, consonance increase, it can be interpreted that an increase in cognitive consonance leads to professional behavior at a higher level. Regarding lack of studies in this area, it was not viable to compare the relationship between professional behavior and cognitive dissonance in other nursing populations.\u003c/p\u003e \u003cp\u003eThe present study divulged a significant association between professional behavior and the variables: the average number of patients, the level of interest in nursing, taking psychiatric medication, and overtime working hours.\u003c/p\u003e \u003cp\u003eAiken et al. (2002) addressed hospital nursing staff deficiency and patient mortality, nurse burnout, and job dissatisfaction. They stated that as the number of patients under care gets more, patient mortality, nurse burnout, and job dissatisfaction increases (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Hayter et al. (2013) in their research as Key Messages for Nursing also reported that the more standardized the nurse-patient ratio and the more skilled the nurses, the higher the quality of care provision (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). As reported by the current research, a direct significant relationship was observed between the number of patients and the professional behavior score of nurses, the finding which is somewhat contradictory to previous studies. Although it can be claimed that the staff with a higher number of patients per shift acquire certain skills compared to other nurses, which might be effective in the occurrence of professional behavior. On the other hand, it is probable that such nurses have reported high professional behavior due to occupational or environmental reasons and using self-report questionnaires, which partially justifies this relationship.\u003c/p\u003e \u003cp\u003eDyrbye et al. (2020) in their research as Relationship between Burnout and Professional Behaviors and Beliefs among US Nurses found an inverse significant relationship between burnout and professional behavior (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Besides, as displayed by the study of Stelnicki et al. (2021), titled Associations between Burnout and Mental Disorder Symptoms among Nurses in Canada, a direct meaningful relationship was discovered between burnout and the outbreak of psychiatric disorders (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Considering such cases, it can be indirectly concluded that the prevalence of psychiatric disorders may be associated with declined professional behavior. In the current study, no significant relationship popped up between the professional behavior score and the outbreak of psychiatric illness, while the professional behavior score of the nurses taking psychiatric medication was tangibly higher than those not doing so. The contrast observed in the present study is likely due to the effective treatment and promoted psychological and social functioning of such individuals with diagnosed disorders compared to other populations. It is recommended to conduced further investigation on this issue in future studies.\u003c/p\u003e \u003cp\u003eIn the study performed by Bagherzadeh (2021), called Predicting Role of Safety Climate in Professional Behavior of Nurses, the average level of interest in nursing was reported as 7.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27 on the scale 1\u0026ndash;10, and the mean score of professional behavior among the nurses rating their interest in nursing higher was critically more (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). This is also true in the research of Heshmati-Nabavi et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In the present study, the mean and standard deviation of the score of interest in nursing was reported as 5.76\u0026thinsp;\u0026plusmn;\u0026thinsp;2.80 from 1 to 10 by the nurses, and there was a positive significant relationship between the level of interest in nursing and the score of professional behavior. Watanabe and Yamauchi (2018) in their study, known as Effect of Quality of Overtime Work on Nurses' Mental Health and Work Engagement, indicated the negative effect of imposed overtime on nurses' mental health and job engagement (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). The current research also reported professional behavior drop as the hours of overtime work increase, the finding which can be indirectly congruent with their study drawn results.\u003c/p\u003e \u003cp\u003eIn this study, professional behavior did not expose a significant relationship with age, gender, marital status, academic degree, job commitment status, work experience, the type of work shift, and the history of stressful events in the past 6 months. As reported by the study done by Khajavi et al. (2020), no critical relationship was spotted between professional behavior and the variables of age, academic degree, job commitment status, work experience, work shift, and the history of stressful events, but gender (women) and marital status (being single, widow or widower) are the important predictors of professional behavior (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The study done by Jahanbazi and lotfizadeh (2019), as Investigation Relationship between Professional Behavior and Job Well- Being among Nurses in Shahrekord's Educational Hospitals, revealed an inverse tangible relationship between age and professional behavior, and the professional behavior score was significantly higher in women than in men and in the nurses with a bachelor's degree than in other academic degrees (associate or master's degree) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Yet, the study of Hisar et al. (2010), tiled Determining Professional Behavior of Nursing Executive, and that of Konukbay et al. (2014), known as Determining Professional Behaviors of Nurses Working in an Educational and Research Hospital, reported a significant relationship and increased mean score of professional behavior by higher academic degree (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Differences in demographics, cultural, environmental, research method, and working conditions may be the factors contributing to this discrepancy.\u003c/p\u003e \u003cp\u003eEarlier in this study, no major relationship was reported between the scores of professional behavior and work experience. Consistent with the present study, the research performed by Heshmati-Nabavi et al. (2014) indicated no meaningful relationship between professional behavior and work experience (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), while the study by Tanaka et al. (2016), called Professional Behaviors and Factors Contributing to Nursing Professionalism among Nurse Managers, reported that the more the history of working years, the higher the professional behavior gets promoted (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). This discrepancy may be under the influence of various work environments.\u003c/p\u003e \u003cp\u003eAdditionally, the current study reported no tangible association between the score of professional behavior and the type of ward and work shift. Unlike this, in the research of Din\u0026ccedil; and Yıldız (2023), on Evaluation of Relationship between Job Satisfaction and Professional Behavior in Pediatric Nurses, a statistically meaningful difference was reported between the mean scores of professional behavior of nurses considering the type of ward. Moreover, their study showed the score of professional behavior of morning shift nurses as significantly higher than that of night or rotating shift working nurses (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). It is worth mentioning that the results of the study performed by Ruiz-Fern\u0026aacute;ndez et al. (2020), on Quality of Life in Nursing Professionals Nurses: Job Burnout, Fatigue, and Satisfaction, reported lower burnout in the morning shift than in other work shifts (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Since increased burnout has a negative effect on the level of professional behavior (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), it can be concluded that the type of work shift may indirectly affect professional behavior.\u003c/p\u003e \u003cp\u003eIn addition to the above stated findings of the current study, there was no significant relationship between the score of professional behavior and satisfaction with the ward. The results of the study by Jahanbazi et al. (2019) demonstrated professional behavior and job well-being having a significant positive relationship (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Regarding that satisfaction with the workplace is one of the dimensions of job well-being, the findings of the current study may indirectly contradict those reported by the study of Jahanbazi et al. (2019).\u003c/p\u003e \u003cp\u003eConsidering the questionnaires being of self-report nature, one of the study limitations is the likelihood of bias and lack of precise responses by the staff due to job considerations or the concerns about incorrect judgment. Also, the current study was carried out in only one geographical area, so it is not possible to generalize the results to the entire nursing community. Moreover, the limited research related to the cognitive dissonance variable has made it tough to analyze and compare the results.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMaryam Asri worked on the data collection and writing the first draft of the articleA. Hossein-Nataj performed the data analysis and interpreted the results. V. Shafipour was the advisor of the article.H.Azimi lolaty designed and supervised the workAlso All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e \u003cp\u003eThe authors would like to sincerely appreciate the Deputy of Research and Technology of Mazandaran University of Medical Sciences, the Executive of Sari-based Teaching Hospitals, and all nurses lending us a hand in conducting this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKhajavi Z, Vaezzadeh N, Mousavinasab SN, Azimi Lolaty H. Relationship between Ethical Intelligence and Professional Behavior in Nurses. J Mazandaran Univ Med Sci. 2020;30(185):86\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhachian A, Ashghali Farahani M, Haghani H, Ahmadi Tameh M. Evaluation nurses' professional behavior and its relationship with organizational culture and commitment in 2015. Int J Med Res Health Sci. 2016;2(12):247\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJabari F, Ooshaksaraie M, Azadehdel M, Mehrabian F. Relationship between patient safety culture and professional conduct of nurses in context of clinical governance implementation. J title. 2015;25(3):27\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMousaviasl S, Elhami S, Ban M, Zahedi A, Arizavi Z. Comparison between the professional behavior of nursing students and employed nurses. J Advanc Pharm Educ Res| Apr-Jun. 2019;9(S2):173\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJahanbazi r, lotfizadeh m. Investigation the Relationship between Professional Behavior and Job Well- Being among Nurses in Shahrekord's Educational Hospitals. Hospital. 2019;18(1):43\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBagherzadeh R, Salemipoor Y, Hajinejad F, Heidari F, Vahedparast H. 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J Nurs Adm Manag. 2016;24(1):12\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDin\u0026ccedil; F, Yıldız D. Evaluation of the relationship between job satisfaction and professional behaviors in pediatric nurse. Eur J Clin Experimental Med. 2023(3):553\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuiz-Fern\u0026aacute;ndez MD, P\u0026eacute;rez-Garc\u0026iacute;a E, Ortega-Gal\u0026aacute;n \u0026Aacute;M. Quality of life in nursing professionals: Burnout, fatigue, and compassion satisfaction. Int J Environ Res Public Health. 2020;17(4):1253.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStern DT, Frohna AZ, Gruppen LD. The prediction of professional behaviour. Med Educ. 2005;39(1):75\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Professional Behavior, Cognitive Dissonance, Nursing, Behavior","lastPublishedDoi":"10.21203/rs.3.rs-8521538/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8521538/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and Purpose\u003c/h2\u003e \u003cp\u003eRegarding the direct connection between nurses and patients and the increasing focus on promoting professional behavior, it is highly critical to recognize and examine the factors influencing professional behavior. Cognitive dissonance arises when two or more cognitive elements are conflicting and is followed by psychophysiological impacts and may affect behavior. Thus, the current study was conducted pursuing the goal to find out the relationship between professional behavior and cognitive dissonance among the nurses working in the teaching hospitals of Mazandaran University of Medical Sciences.\u003c/p\u003e\u003ch2\u003eMaterial and Methods\u003c/h2\u003e \u003cp\u003eIn this descriptive-analytical study, 235 nurses working in the wards of teaching hospitals affiliated with Mazandaran University of Medical Sciences were randomly selected by stratified sampling method. The study tools encompassed a demographic checklist, Harmon-Jones Dissonance Arousal and Reduction Questionnaire (DARQ), and Goze\u003csup\u003e,\u003c/sup\u003es Nursing Students Professional Behavior Scale(NSPBS). The statistical analysis was done by descriptive statistics, Pearson correlation coefficient, t-test, ANOVA, and multiple linear regression using SPSS-22. In all cases of statistical analysis, the level of significance less than or equal to 0.05 (P\u0026thinsp;\u0026le;\u0026thinsp;0.05) was taken into account.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe current study drawn results revealed that 80.9% of nurses were women with the mean age and work experience of 32.90\u0026thinsp;\u0026plusmn;\u0026thinsp;7.74 and 8.43\u0026thinsp;\u0026plusmn;\u0026thinsp;7.46, respectively. Besides, the participants\u0026rsquo; nursing professional behavior score was 109.79\u0026thinsp;\u0026plusmn;\u0026thinsp;14.55 and cognitive dissonance score was 83.11\u0026thinsp;\u0026plusmn;\u0026thinsp;9.45. The findings also reported a direct significant relationship between professional behavior and cognitive dissonance reduction (increased score) (P\u0026thinsp;=\u0026thinsp;0.00, r\u0026thinsp;=\u0026thinsp;0.256).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study findings displayed the mean score of nursing professional behavior as high, and the mean score of cognitive dissonance was in the range of dissonance reduction. In other words, the higher the mean score of Dissonance Arousal And Reduction Questionnaire, the lower the level of dissonance-induced arousal and higher ability to reduce negative dissonance-induced feelings(defind as consonant cognition).\u003c/p\u003e","manuscriptTitle":"Relationship between Professional Behavior and Cognitive Dissonance in Nurses Working in Teaching Hospitals","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-07 14:51:39","doi":"10.21203/rs.3.rs-8521538/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"54f6c9f6-0d2b-44d8-b677-bdcd8257d00a","owner":[],"postedDate":"January 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-03T21:53:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-07 14:51:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8521538","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8521538","identity":"rs-8521538","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}