Health, Spirituality and Medical Ethics

Spirituality and ethics are the core values shaping human life from ancient times (1). The term spirituality has different meanings and can be usually considered identical with the word religion. However, it is important to distinguish between religion and spirituality since they are not of the same nature and are two different concepts while being relevant (2)
Spirituality is defined as a personal quest to search for the deeper meaning of life in relation to God and universe. There are common concepts associated with this structure, such as communication with the inner self, search for common values beyond personal effort, a deep empathy with all aspects of life, and a desire to be linked with the sources of life (3).
Given the positive effects of spirituality on the improvement of main psychological structures, such as life satisfaction (4, 5) mental health (6, 7), and happiness (8), as well as the negative effects of perceived everyday stress (9), this concept has been taken into consideration in the workplace and developed greatly. A growing number of employees are seeking meaning in work as they are looking for meaning in their personal life given the fact that although life without work is pointless, soulless work also ruins life (10).
In addition to employees, large organizations support workplace spirituality due to its higher impact on their success, compared to other factors (11). In this regard, the employment of spirituality facilitates the organizations to create a human environment based on human values in which employees can flourish all their talents, thereby gaining profits (12). This steadily-growing paradigm has attracted more fans (13) and resulted in a dramatic increase in the number of books and journals in the field.
As reported by Karakas (14), 140 articles have shown the positive effect of spirituality in the workplace on organizational performance. Spirituality in the workplace is reported to have a positive relationship with organizational citizenship (15), organizational commitment (16, 17), effectiveness of the organization and employees (14), and effective leadership (18). It can also lead to the promotion of health and happiness in the workplace (19), improvement of employees’ attitude toward job involvement, reduction of quitting job intentions (20), and decrease of moral failures in the workplace (3).
In the 21st century, organizations need a spiritual basis to survive because this concept can make employees satisfied with their whole working experience (21). Fachrunnisa (22) believes that all organizations need spirituality in their workplace to create job satisfaction. Marques (23) stated that the enhancement of satisfaction or dissatisfaction in the workplace is associated with one's perception about the meaningfulness or meaninglessness of the work. Spirituality in the workplace can lead to the enhancement of employees’ job satisfaction through increasing honesty (24). According to the latest studies, there is a positive relationship between spirituality in the workplace and job satisfaction (16).
Job satisfaction is defined as a positive or negative attitude to work (25), as well as a positive emotional situation resulting from one's evaluation of work or work experiences (26). If employees are satisfied with what they are doing, they are less willing to quit their jobs (20). A job is an important aspect of life, which has to meet the mental needs of the individuals, in addition to the provision of their life expenses.
Job motivation is among the important job-related mental factors. Motivation is one of the key concepts in organizational environments (27) since the lack of job motivation leads to the non-fulfillment of positive outcomes at work (28). Job motivation can increase productivity (29) and encourage the employees to be more efficient, create a positive working environment, and fulfill their schedule successfully (28). Fry (30) introduces spirituality in workplace as a proximal factor for employees’ intrinsic motivation. Various studies have also reported a significant positive relationship between motivation and spirituality in the workplace (20, 21, 31). Spiritual experience increases job satisfaction (32).
The fulfillment of spiritual needs in the workplace makes for more professional individuals in the job (33). On the other hand, the investigation of spiritual dimension has been ignored for many years in comparison with employee’s physical and psychological dimensions (32). Additionally, despite the official reports testifying the increased tendency among American employees for using spirituality in the workplace (34), little attention has been given to spirituality in the eastern societies (35).
However, few studies have been carried out in Iran examining spirituality in the workplace and its relationship with job satisfaction and motivation. In the local studies, the variables predicting job satisfaction and motivation were mainly psychological, managerial, or social (36, 37). Moreover, spirituality in the workplace has been proposed as a way of coping with stressful situations (38).
The teachers in the schools of mentally challenged children are subject to stressful work conditions, which in turn can affect their job satisfaction and motivation. With this background in mind, the present study was conducted to investigate the relationship between spirituality in the workplace and job satisfaction and motivation among the teachers of mentally challenged schools in order to determine the role of spirituality elements in the workplace as predictors of these two variables.
 
Methods
This descriptive-correlational study was conducted on 80 teachers working at special education schools of Kerman in southern Iran in 2014. The participants were selected from 17 exceptional schools in districts 1 and 2 of Kerman. Because of the small population, it was possible to measure the variables of the study for every individual. Therefore, the census sampling technique was used in the study.
After obtaining permission from relevant authorities and going to the schools where teachers were working, three questionnaires were distributed among them. To comply with the rules of ethics, teachers were reassured that their information was kept confidential and analyzed by a researcher team. In addition, they were not obliged to participate in the study. Out of the 80 subjects, 6 people withdrew, and 74 people finally took part in the study.
 
Materials
Workplace Spirituality Scale
In order to measure spirituality in the workplace, Workplace Spirituality Scale, developed by Milliman et al. (39) was used in the study. This scale consists of 21 items dividing into 3 subscales of meaningful work (6 items), sense of community (7 items), and alignment of individual values with organizational values (8 items). This questionnaire is rated on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (totally agree).
The reliability of this instrument was investigated in different studies, reporting the Cronbach’s alpha coefficients of 0.79, 0.88, 0.91, and 0.94 for total scale and its three subscales of meaningful work, sense of community, and alignment with organizational values, respectively (39, 40). The validity of this tool was measured through item-total correlation rendering correlation coefficients of 0.82-0.94, indicating its proper validity. The reliability of this questionnaire was also verified using factor analysis (39).
 
Dant’s Job Satisfaction Questionnaire
This questionnaire was developed by Dant et al. in 1966 in form of Herzberg’s two-factor theory and contains 36 items rated on a 7-point Likert scale. In this instrument, points 1 and 7 represent the lowest and highest degrees of agreement, respectively. The questionnaire was translated to Persian by Mojaradzadeh (1994) and normalized by Fathabadi (2008) for the Iranian society (41). The validity of the questionnaire was confirmed, rendering a Cronbach’s alpha of 0.94 (42).
Habibi’s Job Motivation Questionnaire
This 30-item questionnaire was designed by Habibi (1998) in Persian to examine job motivation. This tool is rated on a 5-point Likert scale ranging within very little, little, medium, much, and too much. Items 23 and 27 are scored inversely. The reliability of the questionnaire was confirmed by Habibi (1998), reporting a Cronbach’s alpha coefficient of 0.93 (43). In another study, the reliability and validity of this tool were verified as 0.93 and 0.82, respectively (44).
Statistical analysis
Data analysis was performed in SPSS (version 20) using Pearson correlation coefficient and stepwise regression. Before investigating the hypotheses of the research, the normality of the data was confirmed using Smirnov-Kolmogorov and Shapiro-Wilk tests. The other statistical assumptions of regression method, including the lack of multicollinearity (VIF<10; tolorance>0.01) and multiple non-overlapping (correlation between independent variables <0.95) were fulfilled.
 
 
 
 
 
Results
The demographic characteristics of the participants, including gender, age, work experience, education level, and marital status are tabulated in Table 1.
Table 1- Demographic characteristics of the participants

Mean±SD	%	N		Variables
-				Gender
	100	74	Female
	-	-	Male
43±9.33				Age
	9.5	7	30 ≥ years
	60.8	45	31-40 years
	25.7	19	41-50 years
	4.1	3	50 < years
17±3.71				Work experience
	29.7	22	10 ≥ years
	52.7	39	11-20 years
	17.6	13	21-30 years
-				Education level
	10.8	8	High school diploma
	17.6	13	Associate degree
	54.1	40	Bachelor of arts/science
	17.6	13	Master of arts/science
-				Marital status
	70.3	52	Married
	29.7	22	Single

 
The correlation between described variables and spirituality indicators are presented in Table 2. The results revealed a significant relationship between the three components of spirituality in the workplace and motivation and job satisfaction.
 
 
 
 
Table 2- Correlation matrix of spirituality in the workplace components with described variables

	Variables	Mean±SD	1	2		3		4		5
1	Meaningful work	19.28±7.12	1
2	Sense of community	14.02±5.81	.73***		1
3	Alignment with values	13.94±5.12	.66***		.71***		1
4	Job satisfaction	84.19±17.91	.69***		.35**		.57***		1
5	Job motivation	68.45±14.31	.31**		.55***		.20**		.54**		1

    P<0.05^*; P<0.01^**; P<0.001^***
In the first stepwise regression with regard to motivation as a dependent variable, a significant model was observed in one step. The first step included the sense of community at work (F ([1, 73]=39.24, P≤.001). Based on the statistics, 0.35% of the changes in job motivation could be explained based on the sense of community component (P≤0.001). The other two components were excluded because they were not meaningful (Table 3).
 
Table 3- Predicting job motivation on the basis of spirituality in the workplace

Variable	B	b	t	Sig
Step one Sense of community
	2.10	0.59	8.05	0.000

 
In the second stepwise regression, considering job satisfaction as a dependent variable, there was a significant model in three steps. The first step included meaningful work, (F [1, 73]=108.51, P≤0.001), second step included alignment with organizational values (F [1, 73]=59.93, P≤0.001), and the third step entailed a sense of community (F [1, 73]=44.58, P≤0.001). According to the results, meaningful work (P≤0.001) and profound alignment with organizational values (P≤0.001), and sense of community (P≤0.001) could predict 35%, 0.15%, and 0.5% of the job satisfaction variance, respectively (Table 4).
 
Table 4- Predicting job satisfaction based on spirituality in the workplace

Variable	B	b	t	Sig
Step one
Meaningful work	4.25	.45	3.81	.000
Step two Alignment with organizational values
	1.19	.25	2.66	.000
Step three Sense of community
	2.19	.22	2.40	.000

 
Discussion
In this study, we investigated the relationship of spirituality at workplace with motivation and job satisfaction. The results revealed that spirituality at workplace was significantly associated with job motivation. Among the components of spirituality in the workplace, the sense of community was the only predictor of job motivation in the special education school teachers. This finding is in line with the results obtained by De-Klerk et al. (21), Afsar et al. (40), and Chalosfsky and Krishan (29), reporting a significant relationship between job motivation and spirituality in the workplace.
The concept of motivation refers to the cause, intensity, and direction of human’s behavior, which manifests in the person’s behavior or attitude toward his/her work (45). Spirituality at workplace is also associated with organizational commitment (16). Therefore, increased commitment and attention to all work-related responsibilities can be one of the reasons for the relationship between spirituality in the workplace and job motivation.
The increased sense of belonging to a group can be another reason for this finding because the sense of community in the group includes a sense of deep connection with others (43). This concept is based on the belief that individuals feel a sense of bond with each other, and there is a relationship between their own inner self and the inner self of others (39).
The study of the relationship between spirituality in the workplace and job satisfaction indicated a significant relationship between the two variables. Based on the results, spirituality components in the workplace, including meaningful work, alignment with organizational values, and sense of community, respectively predicted teachers’ job satisfaction (P≤0.001). This finding is in line with the results of the studies performed by Vander-Walt et al. (42), Fachrunnisa (22), Rolland et al. (16), Hassan et al. (24), Goodarzi and Kaviani (46), Choerudin and Ahmad (47), Javanmard et al. (48), and Vander-Walt and de Klerk (32).
In explaining the relationship between spirituality in the workplace and job satisfaction, it is worth mentioning the opinions of the experts in the field of job satisfaction. Being in line or alignment with organizational values is among the factors, which can turn the workplace into a meaningful and attractive atmosphere. Terez (49) believes that a clear perspective of the future, which determines the common orientation of the people in the organization, and the objectives and topics, which tangibly complete this perspective on a daily basis, cause people to trust the future more. Accordingly, they feel that tactful and clear solutions are dominating the organization, which is in line with the results of the present study.
According to a study conducted by Rollinson et al. (50), organizations that adopt a monist view and a broad set of values and beliefs to clarify and improve the working lives of their members, provide a more appropriate platform for performing tasks, reducing pressures, and finally increasing job satisfaction. In such organizations, the employees feel that they are in an integrated set, and organizational duties are shared among all members in light of relationship and correlation. Based on Terez (49), correlation and integration are considered as the major sources of job satisfaction confirming the results of the present study.
In general, the results of this study showed that spirituality in the workplace was positively correlated with job motivation and satisfaction. This finding highlights the significance of attention to spirituality in the workplace, which is in line with the studies introducing paying attention to spirituality in the workplace as a new and necessary paradigm (47) and considering it essential to have a spiritual basis for the survival of the organization (51).
Moreover, this positive relationship in special education school teachers in the present study can be due to the reduction of perceived stress (9), quitting job intentions (20), and moral behavior failure in the workplace (3), as well as the improvement of organizational commitment (16, 17), health and happiness in the workplace (19), job-related attitudes of employees about job involvement (34), and ability to cope with stressful work conditions (33), created by spirituality in the workplace.
Given the significant relationship of spirituality in the workplace with job satisfaction and motivation, future studies are recommended to investigate the mediating role of job motivation in the relationship of spirituality with job satisfaction and also the related factors, which are effective in the enhancement of spirituality using causal investigations, structural modeling, and path analysis. One of the limitations of the study was the small sample size. Therefore, the generalization of the findings of the study should be performed with discretion.
Conclusion
Motivation is a dynamic drive forcing the humans to move towards the goal with specific acts. Job satisfaction is defined as the experience of happiness resulting from the achievement of the objectives. Motivation is a feeling created before performing an action and achieving results, whereas satisfaction is a feeling generated after reaching the objectives. Therefore, motivation can be defined as a driving force along this path.
Regarding the role of spirituality in the workplace in the prediction of these two issues, the relationship between spirituality and job satisfaction can be examined in terms of the mediating role of job motivation. It can be concluded that job motivation is the factor directing one toward the achievement of the goal and job satisfaction.
 
Acknowledgments
The authors are thankful to all special education teachers that patiently helped in completing research questionnaires and also those researchers that made this research possible by their scientific documentations.
 
Funding
The present study is not supported by any grant.
Ethical Consideration
All procedures performed in the study involving human participants were in accordance with the ethical standards of the Psychology Department at Shahid Bahonar University of Kerman as well as the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
 
Informed consent
Informed consent was obtained from all participants included in the study.
 
Conflicts of interest
The authors declare no conflicts of interest.
 
 
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