however , knowledge management is a challenging process , because managers should extract knowledge from staff mind and organizational processes and share it among other staff ( 1 ) .
knowledge management is a strategy for acquiring right knowledge from right staff at right time as well as sharing and using such knowledge toward improving performance of the organization ( 2 ) .
alavi and leidner ( 3 ) emphasized on creating and acquiring internal and external knowledge as well as storing and sharing the knowledge . by creating knowledge ,
the ability of organization to develop new knowledge , ideas and solutions is under consideration . by developing and renewing previous and current knowledge using a variety of methods
moreover , all staff need to have access to the knowledge required to accomplish their tasks ( knowledge dissemination / sharing ) . finally , knowledge usage implies that the organization needs to use created knowledge to represent and improve its quality of products , services and processes ( 4 , 5 ) .
a common belief is that organizations need to foster an environment for managing , sharing and transferring knowledge among staff ; however , many studies showed that several organizations attempts to implement knowledge management have failed ( 6 ) .
in general , iranian studies revealed poor status of knowledge management implementation in hospitals and health centers ( 7 ) .
a great portion of healthcare services is performed by nurses ( 8) and they possess considerable knowledge regarding healthcare services .
therefore , they can be of great help to create knowledge for provision of different services .
the nursing processes cover variety of activities , all of which are dependent on knowledge . in this
( 5 ) provided a framework for km in nursing practices . from their points of view , nursing practices including assessment , making a nursing diagnosis , developing and implementing a care plan as well as evaluation are dependent on creation , codification , transfer and application of knowledge ( 5 ) .
anderson and willson ( 9 ) argued that km is valuable to organize nursing knowledge , so that it improves quality of healthcare services .
many studies illustrated that successful implementation of km depends largely on performance of managers ( 10 - 12 ) . in this
regard , studies argued that nurse managers should play a key role in development of a supportive culture for knowledge management in their wards ( 5 , 13 ) . obviously , effective human resource management is an influential factor to implement km in hospitals .
studies showed that people s role to facilitate and drive the km process and that of team leaders are crucial for successful km ( 14 ) .
one of the most important aspects of human resource management is staff 's quality of work life ( qwl ) and their satisfaction with the job ( 15 , 16 ) .
previous researches showed that putting more emphasis on staff s qwl and their satisfaction results in more participation in different organizational affairs and better performance ( 17 ) .
quality of work life refers to a set of work conditions in an organization such as salary , allowance , leisure facilities , health services , safety , participation in decision - making , managerial factors , job development and enrichment ( 8 , 18 ) .
several studies showed that work life quality of nurses in developing and developed countries is not much satisfactory or at a moderate level ( 8 , 17 - 21 ) .
dissatisfaction with job and poor perception of qwl may be effective on variety of nurses and nurse managers activities ( 22 ) including knowledge management .
to our knowledge , many of studies regarding qwl were performed on nurses rather than nurse managers .
additionally , there is a paucity of studies on the association between qwl of nurse managers and their participation in implementation of km strategies .
the present study was conducted to assess the association between qwl of nurse managers and their participation in implementing knowledge management .
in this cross sectional study , all nurse managers ( matrons and supervisors ) in 11 hospitals affiliated with the social security organization in tehran , iran ( 71 managers ) were participated .
part b ( knowledge management questionnaire ) with 20 questions was developed based on a literature review ( seven questions on knowledge creation , seven questions on knowledge sharing , two questions on knowledge storage and four questions on knowledge usage ) .
we adopted related questions from previous developed iranian or international questionnaires ( 7 , 23 - 27 ) .
the nursing mangers were asked to evaluate their participation in implementing each of the above dimensions at a five - point scale ( very low to very high ) . part c ( quality of work life questionnaire ) with 31 questions was developed based on a literature review ( 8 , 17 - 20 , 28 , 29 ) . in this questionnaire ,
financial facilities were determined with two questions , educational facilities with four , managerial factors with five , participation in decision making with four , job design with six , communication and teamwork with five , work environment with three and job satisfaction with two questions ( general satisfaction and tendency to leave the job ) . with these questions , we asked managers to evaluate their perception of their qwl .
the questions were based on a five - point likert scale ( very low to very high ) .
the questionnaire was reviewed by three faculty members of a nursing department ( with job experience as a nurse manager ) .
they were asked to rate the importance and clarity of each question from 1 to 4 ( 1 = low importance / clarity to 4 = high importance / clarity ) .
the mean score of all questions was more than three ; therefore , no question was removed .
for these questions , we implemented some minor changes in wordings of the question for more clarity .
additionally , in a pilot study , we asked 10 nurse managers ( who were from other hospitals ) to complete the questionnaire .
in addition , the floor and ceiling effects were checked by calculating the percentage of managers with the lowest and highest possible scores , respectively .
the effects should be less than 20%(30 , 31 ) . to check reliability of the questionnaire ,
the coefficients for knowledge management and quality of work life questions were 0.94 and 0.96 , respectively .
the questionnaires were handed over to the participants from may to june 2012 and returned after three reminders . finally , 55 managers from 11 hospitals participated in the study ; however five of the questionnaires were excluded as many questions were left blank ( response rate = 70.4% ) . for data analysis ,
the responses were first scored ( very low = 1 to very high = 5 ) .
the data was analyzed using mean of scores , t - test , anova test and related non - parametric methods ( if the distribution was not normal based on the kolmogorov - smirnov test ) , pearson s correlation coefficient ( based on the kolmogorov - smirnov test , data distribution was normal for the total score of km and qwl ) , as well as linear regression ( enter method ) using the spss software ( version 16 , spss inc .
scores below 25% of the total score were considered as low ( weak ) , 25 - 50% as moderate , 51 - 75% as relatively good and more that 75% of the total score as good . to conduct the research , the study protocol was provided to hospital managers for authorization .
questionnaires were anonymous and the nurse managers were informed about the research and its purposes .
the participants were provided with an information sheet regarding their rights such as confidentiality and anonymity .
in this cross sectional study , all nurse managers ( matrons and supervisors ) in 11 hospitals affiliated with the social security organization in tehran , iran ( 71 managers ) were participated .
part b ( knowledge management questionnaire ) with 20 questions was developed based on a literature review ( seven questions on knowledge creation , seven questions on knowledge sharing , two questions on knowledge storage and four questions on knowledge usage ) .
we adopted related questions from previous developed iranian or international questionnaires ( 7 , 23 - 27 ) .
the nursing mangers were asked to evaluate their participation in implementing each of the above dimensions at a five - point scale ( very low to very high ) . part c ( quality of work life questionnaire ) with 31 questions was developed based on a literature review ( 8 , 17 - 20 , 28 , 29 ) . in this questionnaire ,
financial facilities were determined with two questions , educational facilities with four , managerial factors with five , participation in decision making with four , job design with six , communication and teamwork with five , work environment with three and job satisfaction with two questions ( general satisfaction and tendency to leave the job ) . with these questions , we asked managers to evaluate their perception of their qwl .
the questions were based on a five - point likert scale ( very low to very high ) .
the questionnaire was reviewed by three faculty members of a nursing department ( with job experience as a nurse manager ) .
they were asked to rate the importance and clarity of each question from 1 to 4 ( 1 = low importance / clarity to 4 = high importance / clarity ) .
the mean score of all questions was more than three ; therefore , no question was removed .
for these questions , we implemented some minor changes in wordings of the question for more clarity .
additionally , in a pilot study , we asked 10 nurse managers ( who were from other hospitals ) to complete the questionnaire .
in addition , the floor and ceiling effects were checked by calculating the percentage of managers with the lowest and highest possible scores , respectively .
the effects should be less than 20%(30 , 31 ) . to check reliability of the questionnaire ,
the coefficients for knowledge management and quality of work life questions were 0.94 and 0.96 , respectively .
part b ( knowledge management questionnaire ) with 20 questions was developed based on a literature review ( seven questions on knowledge creation , seven questions on knowledge sharing , two questions on knowledge storage and four questions on knowledge usage ) .
we adopted related questions from previous developed iranian or international questionnaires ( 7 , 23 - 27 ) .
the nursing mangers were asked to evaluate their participation in implementing each of the above dimensions at a five - point scale ( very low to very high ) . part c ( quality of work life questionnaire ) with 31 questions was developed based on a literature review ( 8 , 17 - 20 , 28 , 29 ) . in this questionnaire , financial facilities
were determined with two questions , educational facilities with four , managerial factors with five , participation in decision making with four , job design with six , communication and teamwork with five , work environment with three and job satisfaction with two questions ( general satisfaction and tendency to leave the job ) . with these questions
the questions were based on a five - point likert scale ( very low to very high ) .
the questionnaire was reviewed by three faculty members of a nursing department ( with job experience as a nurse manager ) .
they were asked to rate the importance and clarity of each question from 1 to 4 ( 1 = low importance / clarity to 4 = high importance / clarity ) .
the mean score of all questions was more than three ; therefore , no question was removed .
for these questions , we implemented some minor changes in wordings of the question for more clarity .
additionally , in a pilot study , we asked 10 nurse managers ( who were from other hospitals ) to complete the questionnaire .
in addition , the floor and ceiling effects were checked by calculating the percentage of managers with the lowest and highest possible scores , respectively .
the effects should be less than 20%(30 , 31 ) . to check reliability of the questionnaire ,
the coefficients for knowledge management and quality of work life questions were 0.94 and 0.96 , respectively .
the questionnaires were handed over to the participants from may to june 2012 and returned after three reminders . finally , 55 managers from 11 hospitals participated in the study ; however five of the questionnaires were excluded as many questions were left blank ( response rate = 70.4% ) . for data analysis ,
the responses were first scored ( very low = 1 to very high = 5 ) .
the data was analyzed using mean of scores , t - test , anova test and related non - parametric methods ( if the distribution was not normal based on the kolmogorov - smirnov test ) , pearson s correlation coefficient ( based on the kolmogorov - smirnov test , data distribution was normal for the total score of km and qwl ) , as well as linear regression ( enter method ) using the spss software ( version 16 , spss inc .
scores below 25% of the total score were considered as low ( weak ) , 25 - 50% as moderate , 51 - 75% as relatively good and more that 75% of the total score as good .
to conduct the research , the study protocol was provided to hospital managers for authorization .
questionnaires were anonymous and the nurse managers were informed about the research and its purposes .
the participants were provided with an information sheet regarding their rights such as confidentiality and anonymity .
six of hospitals were specialized ( 54.5% ) ; 4 of them ( 36.4% ) had less than 100 beds , 4 ( 36.4% ) had 100 - 200 beds and the others had more than 200 beds ( 27.3% ) .
the mean age , work experience and management experience of participants were 41.7  4.1 , 17.6  3.6 and 8.5  4.3 , respectively .
moreover , 92% of participants had a nursing degree and 85% were supervisors and 14% matron ( table 1 ) .
the floor and ceiling effects were adequate ( less than 20% for all aspects ( tables 2 and 3 ) .
as listed in table 2 , nurse managers stated that financial facilities were at moderate level ( 5  1.26 ) and other seven axes of qwl were at relatively good level ( 55 - 68.8% of possible score ) .
the total score of qwl was 93.4  19.4 ( of 155 ; 60.2% ) , which implies a relatively good qwl . according to table 3 ,
four aspects of knowledge management were pointed 53.1  13.7 of 100 ( 53% ) .
the results showed that neither of the four aspects of km nor the total score of km had a significant association with gender , age group , work experience , management experience and the size ( the number of beds ) and type of hospitals . implementation of km strategies by matrons ( 58.3  4.2 of 100 ) was better than supervisors ( 52.1  14.8 ) ( p < 0.001 ) .
moreover , implementation of different km aspects by managers with a nursing degree was better than those without nursing education ( 54.1  13.9 vs. 42.2  2.5 ; p < 0.001 ) ( table 4 ) .
we found a significant correlation between qwl of nurse managers and implementing km strategies ( r = 0.82 ; p < 0.001 ) .
furthermore , a positive significant correlation was found between all aspects of qwl and four aspects of km ( except for knowledge storage and work environment ) .
the strongest correlations were found between the total score of km and participation of nurse managers in decision making ( r = 0.82 ; p < 0.001 ) , managerial factors of the job ( r = 0.72 ; p<0.001 ) and job design ( r = 0.66 ; p < 0.001 ) ( not presented in after running the linear regression model , only  participation of nurse managers in decision making  ( of the eight dimension of qwl ) remained in the model ( r = 0.879 , r square = 0.772 ) ( table 5 ) .  
numbers out of parenthesis indicate test statistic ( t in t - test ; f in anova ; u in mann - whitney or chi - square in kruskal - wallis ) and numbers in the parenthesis indicate p value .   significant association .
although previous researches showed that implementing knowledge management has been improved in several organizations ( 32 ) , our study showed that nurse managers participation in implementing km strategies was not very well in iran .
another iranian study showed that hospitals do not acceptably manage knowledge and different aspects of km need more attention .
almost similar moderate and low level results were reported by other iranian studies on implementation of knowledge management ( 7 , 34 ) .
these findings revealed that knowledge management is still an immature field of activity in iranian hospitals and nursing field , in particular .
as our results showed , knowledge creation was not at a good level . in this regard , two strategies including  accepting new ideas  and
 creating new knowledge through holding workshops and seminars  were better implemented than other strategies ( only 22% of responses were low and very low in five - point likert scale ) .
furthermore , as implied by the findings , implementation of strategies for storing and using knowledge was not good , which is consistent with other studies ( 33 ) . in this regard ,  prevention of losing intellectual and knowledge capital 
( 48% high and very high ) and  making decision using the previous knowledge 
on the other hand , our results showed a relatively good qwl of nurse managers , so that only 18% of participants evaluated their qwl at moderate and low levels .
the results revealed that qwl ( especially for participation of nurse managers in decision - making , recognition of managerial factors and improvement of job design ) had a positive significant association with nurse managers participation in km implementation .
moffett s study suggested that welfare of staff is an important factor for km and those organizations that take the responsibility for staff welfare can successfully implement km ( 27 ) .
these results indicated that better implementation of km may be achieved by improving qwl of nurse managers , especially for these three aspects of qwl .
concerning participation in decision - making , only 38% of nurse managers stated that they have been encouraged to participate in decision making or developing long - term ( 24% ) and short - term ( 32% ) plans . regarding the managerial factors
many participants argued that their knowledge and skills are not appreciated ( 66% ) , they did not have enough autonomy to perform their job ( 72% ) and their good performance was not recognized and rewarded ( 72% ) .
concerning job design , many of managers believed that their job was not interesting and they did not have enough authorities ( 74% ) and they did not have enough chance to show their management and leadership skills ( 74% ) .
issues concerning unfair performance assessment and no room for participation in decision - making were highlighted in other studies ( 8 , 18 ) .
these results showed that higher qwl is achievable though improving work condition of nurse managers ( especially regarding decision making , managerial factors and better job design ) , which also may improve participation of nurse managers in implementation of knowledge management strategies .
this study was conducted in governmental hospitals affiliated to the social security organization . additionally ,
although many of nurse managers in the social security organization participated in the study and response rate was relatively good , the results can not be generalized .
other hospitals such as teaching or private hospitals should be considered in future studies . moreover
, lack of any significant association between some of the factors of qwl and km under regression analysis might be due to small sample size .
additionally , our study was cross sectional ; therefore , its design limits our ability to predict an exact causal association between km and qwl .
in addition , there are few studies about the association between km and qwl , especially in the nursing filed and we could not easily compare our results with others to reach a consensus . therefore ,
, the results showed that km strategies are not emphasized enough by nurse managers of these hospitals .
moreover , nurse managers qwl ( especially for participation of nurse managers in decision makings ) may affect nurse managers participation in implementing km strategies in hospitals .
nurse managers should pay more attention to implementation of km in nursing processes . additionally , top managers of hospitals should increase nurse managers qwl , especially , for decision - making , managerial factors of job and job design .
 background : the association between quality of work life and participation in knowledge management is unknown.objectives:this study aimed to discover the association between quality of work life of nurse managers and their participation in implementing knowledge management.materials and methods : this was a correlational study . 
 all nurse managers ( 71 people ) from 11 hospitals affiliated with the social security organization in tehran , iran , were included . 
 they were asked to rate their participation in knowledge management and their quality of work life . 
 data was gathered by a researcher - made questionnaire ( may - june 2012 ) . 
 the questionnaire was validated by content and construct validity approaches . 
 cronbach s alpha was used to evaluate reliability . 
 finally , 50 questionnaires were analyzed . 
 the answers were scored and analyzed using mean of scores , t - test , anova ( or nonparametric test , if appropriate ) , pearson s correlation coefficient and linear regression.results:nurse managers performance to implement knowledge management strategies was moderate . 
 a significant correlation was found between quality of work life of nurse managers and their participation in implementing knowledge management strategies ( r = 0.82 ; p < 0.001 ) . 
 the strongest correlations were found between implementation of knowledge management and participation of nurse managers in decision making ( r = 0.82 ; p < 0.001).conclusions : improvement of nurse managers work life quality , especially in decision - making , may increase their participation in implementing knowledge management . 
1. Background
2. Objectives
3. Materials and Methods
3.1. Settings and Participants
3.2. The Instrument
3.3. Data gathering and Analysis
3.4. Ethical Consideration
4. Results
5. Discussion