Nurses' caring behaviour and its correlation with moral sensitivity

Missed nursing care and its relationship with nurses' moral sensitivity: a descriptive-analytical study

BACKGROUND

Missed care rates are an indicator of healthcare quality. Missed nursing care can reduce patient safety and lead to adverse events. Moral sensitivity enables nurses to interpret and respond to clients' needs according to ethical principles. Despite the importance of moral sensitivity and its role in the quality of care, the relationship between nurses' moral sensitivity and missed nursing care has not been extensively studied. This raises the question of whether there is an association between nurses' moral sensitivity and missed care. This study was conducted to investigate the relationship between nurses' moral sensitivity and missed nursing care in the medical and surgical departments of Imam Khomeini Hospital in Urmia, Iran.

METHODS

A cross-sectional study was conducted in 2022, on 202 nurses working in the medical and surgical departments of Imam Khomeini Medical Education Center, Urmia, Iran. Stratified random sampling was used to select the participants. A questionnaire on demographic characteristics, Kalisch's missed care questionnaire, and Lutzen's moral sensitivity questionnaire were used to collect data. Data were analyzed using the Pearson correlation test and linear regression analysis.

RESULTS

Most participants (52.97%) showed moderate moral sensitivity. Nurses' mean moral sensitivity and total missed care scores were 149.07 ± 21.60 and 59.45 ± 4.87, respectively. Pearson correlation test showed no significant correlation between moral sensitivity scores and the total missed care scores (r = 0.041, p = 0.152). However, in the regression analysis, moral sensitivity (β = 0.213, p < 0.001), age (β = 0.131, p < 0.001), working in rotating shifts (β = 0.183, p < 0.001), monthly income (β = 0.079, p = 0.004), work experience (β = 0.030, p = 0.010), and monthly work hours (β = 0.247, p = 0.010) influenced missed care. Approximately, 0.98% of the variance in the missed care was explained by these variables.

CONCLUSION

Our nurses reported moderate levels of moral sensitivity and a concerning level of missed care. Missed care can have detrimental effects on patient safety. Therefore, nursing managers must address this issue promptly.

Moral sensitivity and caring behavior in nursing interns: the mediating role of empathy

Background

The main purpose of this study is to analyze the relationship between moral sensitivity, empathy, and caring behaviors and to explore the mediating effect of empathy on moral sensitivity and caring behaviors of nursing interns.

Methods

A cross-sectional survey was conducted from August to September 2022 in which 261 nursing interns from two Grade 3A Hospitals in Xi'an participated. The questionnaires used in the survey include the General Information Questionnaire (GIQ), the Moral Sensitivity Questionnaire-Revised Version translated into Chinese (MSQ R-CV), the Chinese version of the Jefferson Empathy Scale (JSE), and the Chinese version of the Caring Behavior Inventory (C-CBI). The obtained data were analyzed through descriptive statistics, a one-way analysis of variance (ANOVA), and Pearson's correlation coefficient, and the mediating effect of empathy was tested through structural equations.

Results

The overall mean of moral sensitivity of nursing interns in two Grade 3A Hospitals in Xi'an is 40.84 ± 8.73, the overall mean of empathy is 100.51 ± 21.56, and the overall mean of caring behavior is (113.81 ± 21.05). Statistical analysis showed that there is a positive correlation between moral sensitivity and caring behavior of nursing interns (r = 0.376, p < 0.01), between their empathy and moral sensitivity (r = 0.336, p < 0.01), and between their empathy and caring behavior (r = 0.394, p < 0.01). The empathy of nursing interns has a mediated effect on the relationship between moral sensitivity and caring behavior. The mediated effect value was 0.14, accounting for 31.82% of the total effect.

Conclusion

The moral sensitivity of nursing interns can have a direct impact on predicting the caring behavior and indirect influences their caring behaviors mediated by empathy, with the latter effect being mediated by empathy. Therefore, nursing educators and hospital administrators should adopt targeted interventions to improve the moral sensitivity and empathy of nursing interns, which can further prove to be beneficial in improving their caring behaviors, leading to enhanced quality of nursing care and reduced nurse-patient conflicts and finally to a stabilized nursing team.

Clinical internship environment and caring behaviours among nursing students: A moderated mediation model

BACKGROUND

Caring behaviour is critical for nursing quality, and the clinical internship environment is a crucial setting for preparing nursing students for caring behaviours. Evidence about how to develop nursing students' caring behaviour in the clinical environment is still emerging. However, the mechanism between the clinical internship environment and caring behaviour remains unclear, especially the mediating role of moral sensitivity and the moderating effect of self-efficacy.

RESEARCH OBJECTIVE

This study aimed to examine the mediating effect of moral sensitivity and the moderating function of self-efficacy on the association between the clinical internship environment and caring behaviours.

RESEARCH DESIGN

A cross-sectional design used acceptable validity scales. The hypothesised moderated mediation model was tested in the SPSS PROCESS macro.

PARTICIPANTS AND RESEARCH CONTEXT

This survey collected data from 504 nursing students in an internship at a teaching hospital in Changsha, China.

ETHICAL CONSIDERATIONS

This study was pre-approved by the ethics committee of the medical school (No. E2022210). Informed consent was obtained from all students.

RESULTS

The clinical internship environment (B = 0.450, 95% CI = [0.371, 0.530]) and moral sensitivity (B = 1.352, 95% CI = [1.090, 1.615]) had positive direct effects on nursing students' caring behaviours. Clinical internship environment also indirectly influenced students' caring behaviours via moral sensitivity (B = 0.161, 95% CI = [0.115, 0.206]). In addition, self-efficacy played a moderating role between the clinical internship environment and caring behaviours (B = 0.019, 95% CI = [0.007, 0.031]), as well as the relationship between the clinical internship environment and moral sensitivity (B = 0.006, 95% CI = [0.003, 0.010]).

CONCLUSION

Moral sensitivity mediates the effect of the clinical internship environment on caring behaviour, and self-efficacy strengthens both direct and indirect effects. This study emphasises the importance of self-efficacy in developing moral sensitivity and caring behaviours in nursing students.

The relationship between subjective compliance with isolation precautions and moral sensitivity in novice nurses: cross-sectional study

BACKGROUND

Increasing compliance with isolation precautions is important in reducing hospital-acquired infections and their consequences. It is not possible to achieve and maintain nurse compliance through supervision, control, pressure, or training. Therefore, nurses must personally demand compliance with isolation precautions. This study aimed to determine the relationship between compliance with isolation precautions and the moral sensitivity levels of nurses who have just started working.

METHODS

This study employed a descriptive and cross-sectional research design. The study population consisted of 456 new nurses recruited during the pandemic. All of the new nurses who volunteered to participate in the study and completed the questionnaires completely were included in the study and 398 nurses constituted the sample of the study. Data were collected from 398 out of 456 novice nurses who agreed to participate in the study. The population coverage rate was 87.28%. Participants were selected using convenience sampling method. The data collection tools included an Introductory Information Form, The Isolation Compliance Precautions Scale (TIPCS), and the Moral Sensitivity Questionnaire (MSQ). Descriptive statistics, correlation analyses, and regression models were used to analyze data.

FINDINGS

The mean score of the MSQ was high (mean ± SD = 90.49 ± 25.94; median (P25-P75) = 84 (range, 74-97), and the score for TIPCS was high (mean ± SD = 79.29 ± 7.68; median (P25-P75) = 82 (range, 76-85)). No correlation was found between MSQ and TIPCS (p > 0.05). According to the regression analysis, although the MSQ did not correlate with TIPCS, compliance with isolation measures was found to increase as the conflict subscale of moral sensitivity increased (β= -0.36, CI= -0.55 to -0.16; p < 0.001). Choosing the profession willingly had a positive correlation with compliance with isolation measures (β = 5.3, CI = 2.4 to 8.3; p < 0.001). In addition, starting the profession at an early age had a positive correlation with compliance with isolation measures (β= -0.49, CI= -0.8 to -0.17; p = 0.002).

CONCLUSION

The conflict sub-dimension of moral sensitivity is an important factor in nurses' compliance with isolation measures, and conducting necessary training and other studies to improve nurses' moral sensitivity may increase their compliance with isolation measures.

The mediating role of moral reasoning in spiritual intelligence and caring behaviors in Iranian emergency nurses

Moral reasoning is necessary to the nursing profession. Therefore, this study aimed to investigate the mediating role of moral reasoning in spiritual intelligence and caring behaviors among Iranian emergency nurses. In this descriptive-analytical study structural equation modeling (SEM) is employed for the data analysis. the minimum required sample size determined by the number of parameters of the model was 18. Considering that 5 to 15 samples were required for each of the parameters; the required sample size was 272. Nurses working in the emergency department of all hospitals in Qom, Iran, were selected by convenience sampling. Demographic characteristics inventory, King's Spiritual Intelligence Self-Report Inventory, Crisham's Nursing Dilemma Test, and Wolf's Caring Behaviors Inventory used for data collection. SPSS (V20) and Mplus were used to analyze the data. The results showed that a significant direct relationship was observed between moral reasoning and caring behaviors. According to SEM results, direct and indirect effects were observed of spiritual intelligence on caring behavior It is therefore recommended managers and hospital officials pay meticulous attention to spiritual intelligence and the power of decision-making in nurses to improve their caring behaviors.

Factors influencing mental health nurses in providing person-centered care

BACKGROUND

Mental health nurses advocate for patients through a person-centered approach because they care for people experiencing mental distress who tend to be limited to exercising their human rights and autonomy through interpersonal relationships. Therefore, it is necessary to provide high-quality person-centered care for these patients by identifying the influencing factors.

AIM

This study aims to identify the factors affecting mental health nurses in performing person-centered care for patients.

RESEARCH DESIGN

This study had a cross-sectional, descriptive-correlational survey design.

PARTICIPANTS AND METHOD

Nurses (N = 166) working at psychiatric wards in Korea completed an online questionnaire on moral sensitivity, attitudes toward people with mental illness, and person-centered care. The t-test and stepwise multiple regression analysis were used.

ETHICAL CONSIDERATIONS

Ethical approval for the study was obtained from the relevant ethics committee.

FINDINGS

Moral sensitivity was a significant factor correlating with the provision and perception of person-centered care. Attitudes toward patients had no effect on person-centered care. The predictor variables for the provision of person-centered care (R² = 0.247) were moral sensitivity (β = 0.33), having a professional qualification (β = 0.19), marital status (β = 0.18), and closed ward (β = -0.15). The predictor variables for the perception of person-centered (R² = 0.150) care were closed ward (β = -0.25), moral sensitivity (β = 0.23), and marital status (β = 0.18).

DISCUSSION AND CONCLUSION

Mental health nurses can strengthen person-centered care by improving moral sensitivity related to the ethical aspect of nursing and professional competence to address the complex needs of patients. Person-centered care needs to be applied more carefully in closed wards where human rights issues may arise. Through these efforts, the dignity of patients can be protected.

Ethical and Moral Conflicts in the Nursing Care of Pediatric Patients With Cancer and Their Families

BACKGROUND

Pediatric oncology nurses encounter ethical and moral dilemmas when providing comprehensive care to pediatric patients with cancer and their families.

OBJECTIVE

The aim of this study was to explore ethical and moral conflicts arising in the field of pediatric oncology from the perspective of nursing professionals.

METHOD

This qualitative secondary analysis was conducted with 10 nursing professionals from a pediatric cancer hospital through semistructured interviews and analyzed using thematic data analysis.

RESULTS

Two themes emerged: (1) living with conflicts intrinsic to the relationships, which describes multiple sources of conflict in the relationships of nursing professionals with the team, with the family, and with seriously ill children, summarizing trigger-sensitive topics to be addressed for its mediation; (2) developing moral resilience, which represents how nurses reframe the conflicts and make use of strategies to avoid being personally harmful.

CONCLUSIONS

The results highlight the challenging work environment of pediatric oncology, recognizing the multiple natures of sensitive topics to nursing professionals during clinical decision making and the incipient strategies in dealing with ethical and moral conflicts.

IMPLICATIONS FOR PRACTICE

This study reveals self-reflection and intuitive strategies as protective factors, which could be applied as a step to support nurses encountering ethical and moral conflicts in pediatric oncology daily practice. Furthermore, because of the limited support services for nursing professionals, it is necessary to foresee institutional policies to embrace the development of moral resilience.

Moral sensitivity and person-centered care among mental health nurses in South Korea: A cross-sectional study

AIM

To identify the predictors of mental health nurses' person-centered care, including moral sensitivity.

BACKGROUND

Person-centered care meets patients' ethical needs by protecting their autonomy and dignity, and respecting their choices; it is essential to enhance patient outcomes. Therefore, it is important to identify the predictors of the practice of advocating patients' rights and dignity, and providing person-centered care among mental health nurses to foster competency and ensure the highest quality of care.

METHODS

This cross-sectional study included 220 mental health nurses in South Korea. It measured their general and work-related characteristics, moral sensitivity, and person-centered care. Multiple regression analysis was conducted to identify the person-centered care predictors.

RESULTS

The most potent person-centered care predictor was moral sensitivity (β=.35, p<.001). Other predictors included prior biomedical ethics education (β=.15, p=.013) and marital status (β=.14, p=.025). The regression model had 28.0% explanatory power.

CONCLUSIONS

Mental health nurses' moral sensitivity must be increased to improve their person-centered care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurses should receive continuous education to remain aware of and maintain a high level of moral sensitivity and be encouraged to continue the person-centered practice. Organizational and policy support is needed to promote the practice of person-centered care in the workplace.