Psychological Capital and Spiritual Well-Being as Predictors of Moral Sensitivity in Nursing Students: A Cross-Sectional Study

Background Adherence to ethical codes is a major pillar of nursing care that is affected by various factors. Identifying these factors can lead to better ethical performance. The present study was conducted to determine critical care nurses' adherence to ethical codes and its association with spiritual well-being (SWB) and moral sensitivity (MS). Methods In this descriptive-correlational study, data were collected using the moral sensitivity questionnaire (MSQ) by Lützén et al., Paloutzian and Ellison's spiritual well-being scale (SWBS), and the adherence to ethical codes questionnaire. The study was conducted on 298 nurses working in critical care units of hospitals affiliated with Shiraz University of Medical Sciences in southern Iran in 2019. This study was examined and approved by the Ethics Committee of Shiraz University of Medical Sciences. Results The majority of the participants were female (76.2%) and single (60.1%), with a mean age of 30.69 ± 5.74 years. The mean scores of adherence to ethical codes, SWB, and MS were 64.06 (good), 91.94 (moderate), and 134.08 (moderate), respectively. Adherence to ethical codes had a positive correlation with the total score of SWB (P < 0.001, r = 0.25) and MS (P < 0.001, r = 0.27). A positive correlation was also observed between MS and SWB (P < 0.001, r = 0.41). Meanwhile, MS (β = 0.21) had a greater effect than SWB (β = 0.157) on adherence to ethical codes. Conclusion Critical care nurses showed a good adherence to ethical codes. MS and SWB also positively affected their adherence to ethical codes. Nursing managers can use these findings to devise plans for the promotion of MS and SWB in nurses and thus help improve their ethical performance.

Purpose: The purposes of this study were to examine the associations among moral reasoning, empathy, communication self-efficacy, and moral sensitivity and to determine predictors of nurses’ moral sensitivity. Methods: Data were collected from 194 nurses in the Republic of Korea. Structured questionnaires consisted of the Moral Sensitivity Questionnaire, Defining Issues Test, Jefferson Scale of Empathy, and Counseling Self-Estimate Inventory. The collected data were analyzed using t-tests, one-way ANOVA, Pearson’s correlation coefficient, and hierarchical regression analysis using SPSS ver. 21. Results: Nurses’ moral sensitivities were significantly associated with frequency of ethical education, empathy, and communication self-efficacy. In hierarchical multiple regression models, the significant factors of nurses’ moral sensitivity were age (β=.21, p=.044), the frequency of experience in ethics education (β=.18, p=.007), empathy (β=.32, p<.001), and communication self-efficacy (β=.25, p=.001), which explained 33.2% of the variance in nurses’ moral sensitivity. Conclusion: Our study findings show that nurses’ moral sensitivity could be enhanced by more frequent ethics education programs. In addition, nursing ethics education might be developed to include potential strategies to improve empathy and self-efficacy in communication for high levels of moral sensitivity in nurses.

Comparison of the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses: A cross-sectional-correlation study

Background: Adherence to ethical standards is a vital component of nursing care and is influenced by various circumstances. Identifying such aspects can improve ethical performance. Objective: This study examined critical care nurses' compliance with ethical rules and their impact on spiritual well-being (SWB) and moral sensitivity (MS). Study Design: The research was primarily descriptive and correlational. Setting: The study was conducted at Bahria Town International Hospital Lahore. Duration of Study: This study was conducted from May 1, 2023, to December 10, 2023. Methods: Data were compiled on the individuals' demographics and three essential questionnaires: the adherence to ethical norms questionnaire, the moral sensitivity questionnaire (MSQ), and the spiritual well-being scale (SWBS). The study included 51 nurses, with the bulk of participants being female (76.4%), single (64.7%), without kids (72.54%), possessing a diploma in nursing (84.3%), and graduates of public universities (66.9%). Results: The mean score of adherence to ethical codes was 64.06±7.11, indicating a satisfactory level of commitment to ethical principles. The mean SWB score was 91.67±10.54, with 74.5% (n=38) falling into the moderate category. The mean scores for existential and religious health were 44.85±6.73 and 47.72±5.53, respectively. The mean MS score was 135.63±10.53, with most subjects falling into the moderate category. Multivariate regression analysis revealed a significant correlation between SWB, MS, and ethical code adherence among nurses (P&lt;0.05).Conclusion: Critical care nurses demonstrated a solid commitment to ethical standards. MS and SWB also improved their commitment to ethical rules. Nursing managers may use these findings to promote MS and SWB among nurses, leading to better ethical performance.

Moral sensitivity may play a role in dealing with ethical issues in ICUs. However, the moral sensitivity of adult ICU nurses in China and its predictors have not been well investigated. To analyse the moral sensitivity of intensive care unit (ICU) nurses and its predictors. A cross-sectional study through convenience sampling was conducted in the ICUs of five hospitals in China between November and December 2022. A total of 331 ICU nurses were recruited. Data were obtained using a self-developed socio-demographic characteristic questionnaire, the Moral Sensitivity Questionnaire, the Jefferson Scale of Empathy-Health Professionals and the Organizational Climate Scale for Nursing. The participating institutions received a link to the tools used for online data collection, which they then forwarded to nursing staff. The valid response rate was 96.98% (n = 321). The total mean moral sensitivity score of nurses was 43.04 ± 5.95. The mean scores for empathic ability and organizational climate for nursing were 91.97 ± 17.88 and 101.28 ± 14.77, respectively. Regression analyses revealed that the primary factors associated with moral sensitivity among critical care nurses included work tenure (p < .05), empathic ability (p < .001) and organizational climate (p < .001). High levels of moral sensitivity were found in critical care nurses in China. Work tenure, empathic ability and organizational climate were significant predictors of moral sensitivity in critical care nurses. To enhance the ethical sensitivity of ICU nurses, we suggest to strengthen the training of novice nurses so that they can better face the moral dilemma in clinical practice. In addition, organizational managers should also take measures to create a positive and harmonious working atmosphere, promote the application of moral knowledge in nursing practice and enhance their moral sensitivity.

Moral sensitivity plays a crucial role in clinical decision-making and patient interactions among Emergency Medical Services (EMS) personnel. Although moral sensitivity and professional quality of life have been studied in hospital-based healthcare providers, little evidence exists regarding EMS personnel, who face unique challenges such as heavy workloads, workplace violence, and frequent ethical dilemmas in unpredictable environments. These gaps highlight the necessity of investigating the relationship between moral sensitivity and professional quality of life in this context. This study aims to examine the relationship between moral sensitivity and professional quality of life among EMS personnel. This cross-sectional study was conducted in East Azerbaijan Province, Iran, between March and December 2024. A total of 245 emergency medical technicians (EMTs) were recruited through a two-stage sampling process: EMS stations were first selected by cluster random sampling, and then personnel within the selected stations were enrolled using convenience sampling. Data were collected using the Moral Sensitivity Questionnaire (MSQ) developed by Lützén et al. and the Professional Quality of Life Scale (ProQOL) developed by Charles Figley. Descriptive statistics, Pearson correlation, and regression analysis were used to analyze the data. The findings revealed a significant positive correlation between moral sensitivity and professional quality of life (r = 0.53, p < 0.001). Additionally, moral sensitivity was positively associated with age (r = 0.48, CI [0.38–0.57], p < 0.001), educational level (r = 0.38, CI [ 0.27–0.48], p < 0.001), and work experience (r = 0.68, CI [0.61–0.74], p < 0.001). Regression analysis identified work experience and professional quality of life as significant predictors of moral sensitivity (p < 0.001). No significant relationships were found between moral sensitivity and other factors such as emergency station location, field of study, or shift work. Enhancing moral sensitivity in pre-hospital emergency personnel can improve their professional quality of life and, in turn, the quality of patient care. Thus, developing educational and supportive programs to boost moral sensitivity among these personnel is recommended. Not applicable.

Objectives This study is performed to identify the relationship among calling, nursing professionalism, empathy and moral sensitivity and to identify the predictors of moral sensitivity among nursing students Methods The study utilized a cross-sectional descriptive research design. Data were collected from November 5 to 27, 2020 enrolling 245 nursing students through online survey. The collected data were analyzed using percentage, mean, standard deviation, t-test, ANOVA, Scheffé test, Pearson correlation analysis and hierarchical multiple regression with the SPSS Win 25.0 Program Results The mean score of moral sensitivity was 4.95±0.60 out of a possible 7. Moral sensitivity showed a significantly positive correlation with calling (r=.349, p&lt;.001) nursing professionalism (r=.367, p&lt;.001), empathy (r=.464, p&lt;.001). In the hierarchical multiple regression analysis, empathy (β=.386, p&lt;.001) and nursing professionalism (β=.196, p=.003), along with senior grade (β=-.186, p=.011) were significant predictors and explained 30.6% of variance im moral sensitivity. Conclusions The results of this study showed that empathy, nursing profession and the senior grade are significant factors affecting the moral sensitivity of nursing students. Based on these results, it is essential to develop and implement an education program that considers empathy and nursing professionalism to improve the moral sensitivity of nursing students.

Based on the job demands-resources model and conservation of resources theory, this study examines the association between physical activity and teacher burnout among primary and secondary school physical education teachers, focusing on the mediating roles of mindfulness and spiritual wellbeing. A cross-sectional design was employed to conduct a questionnaire survey among 313 primary and secondary school physical education teachers. Physical activity, mindfulness, spiritual wellbeing, and teacher burnout were assessed using validated scales. Hierarchical multiple regression and bootstrap-based serial mediation analysis (PROCESS Model 6) were employed to test the hypothesized serial mediation model. The results showed that physical activity was associated with teacher burnout through three indirect pathways: (1) the mediating role of mindfulness (Effect = -0.046); (2) the mediating role of spiritual wellbeing (Effect = -0.038); and (3) the sequential mediating role of mindfulness and spiritual wellbeing (Effect = -0.039). The total indirect effect was -0.123. The findings suggest that higher physical activity is associated with lower teacher burnout through both independent and sequential associations involving mindfulness and spiritual wellbeing. These findings should be interpreted cautiously, as the cross-sectional design does not permit causal inference. Nevertheless, the results highlight a potentially meaningful psychological resource pattern that may inform future intervention and longitudinal research.

BackgroundBy incorporating socio-cognitive mindfulness which has been under-examined in the nursing field, this study investigated the relationships between socio-cognitive mindfulness, moral sensitivity, dementia communication behaviors, and dementia nursing performance of nurses in long-term care hospitals. This study also examined the factors influencing nurses’ dementia nursing performance.MethodsA cross-sectional study was conducted with 209 nurses from long-term care hospitals in Korea. Data were collected between August 1 and August 31, 2022. Participants completed the questionnaire assessing their socio-cognitive mindfulness, moral sensitivity, dementia communication behaviors, and dementia nursing performance. Pearson’s correlation and hierarchical multiple regression analysis were performed for data analysis.ResultsDementia nursing performance of the nurses in long-term care hospitals was positively related to their socio-cognitive mindfulness, moral sensitivity, and dementia communication behaviors. Furthermore, nurses’ dementia communication behaviors, moral sensitivity, and total clinical career, in that order, were found to be the factors influencing their dementia nursing performance.ConclusionThe findings indicate that the higher socio-cognitive mindfulness, moral sensitivity, and dementia communication behaviors, the higher dementia nursing performance, and that higher dementia nursing performance is associated with better dementia communication behaviors, greater moral sensitivity, and more extensive clinical experiences. This study provides a foundation for developing effective interventions to enhance dementia nursing performance in the future. To improve dementia nursing performance of nurses in long-term care hospitals, it is necessary to improve dementia communication behaviors and moral sensitivity, and prepare multilateral countermeasures to maintain nurses’ clinical careers.

Objective: To examine the role of spiritual well-being as a mediator and moderator between perceived uncertainty and psychosocial adaptation to multiple sclerosis (MS). Participants and Design: Fifty individuals (40 women, 10 men) diagnosed with multiple sclerosis. Main Outcome Measures: Selfreport measures on illness uncertainty, spiritual (religious and existential) well-being, and psychosocial adjustment to illness were analyzed by a series of hierarchical multiple regression analyses. Results: Both uncertainty and spiritual well-being independently predicted psychosocial adjustment to MS after the influence of demographic and disability-related variables were considered. Spiritual well-being demonstrated a mediator effect but, mostly, failed to show a moderator effect. Conclusion: Spiritual well-being exerts an appreciable influence on adaptation to MS and also acts to mitigate the impact of uncertainty on adaptation. Rehabilitation psychologists may wish to consider its beneficial role as part of their clinical work. Multiple sclerosis (MS), one of the most common disabling diseases of young adults, is an inflammatory demyelinating disorder of the central nervous system with an estimated prevalence of about 250,000‐350,000 individuals in the United States (Devins & Shnek, 2000; Kalb, 1996; Schapiro, 1998). First symptoms usually appear at the young adult age, but the disease may also become evident later in life. The course of MS is highly variable and makes studies of etiology and possible mechanisms of treatment challenging. Because of MS’s highly variable clinical course, individual outcomes cannot be reliably predicted. For many individuals, MS starts with a relapsing‐remitting pattern with episodic exacerbations of neurological dysfunction, which remit completely or partially. Over the years, for most individuals, the disease develops into the secondary progressive form with accumulated disability (Lublin & Reingold, 1996).

Background: In recent decades, spiritual well-being has gained fundamental importance in many healthcare environments. Spiritual well-being is important information about healthcare needs, allowing people to deal with mental stress. Objectives: The present study aimed to determine the spiritual well-being of nurses working in Birjand University of Medical Sciences hospitals in 2022. Methods: In this cross-sectional study, 354 nurses working in the hospitals of the University of Medical Sciences in Birjand City in 2022 were selected by proportional stratified random sampling, and they completed the questionnaire related to demographic information and the standard questionnaire of spiritual well-being. Data were analyzed by SPSS v26 software and ANOVA with Tukey's post hoc test, Pearson correlation, and chi-square at 0.05 significant level. Results: The mean age of the nurses participating was 35.76 ± 7.29 years, and the mean total score of nurses' spiritual well-being was 180.55 ± 16.95. Most of the people in the field of communication with God (78.5%), self (58.8%), others (75.1%), and nature (78.5%), and the total score (52%) were in the medium level of spiritual well-being. There was a significant direct correlation between all dimensions of spiritual well-being (P &lt; 0.001). Also, there was a statistically significant relationship between the mean score of spiritual well-being and age, employment status, and workplace hospital (zage = 7.76; z employment = 18.95; z workplace = 18.62; P &lt; 0.05). Conclusions: Considering that the nurses were medium in terms of spirituality and spiritual well-being, it is suggested to hold educational workshops to improve the level of spiritual well-being of nurses.

BackgroundEthical climate, observance of patients’ privacy and nurses’ spiritual well-being are of great importance in intensive care units (ICU). In addition, it is essential to identify spiritual and ethical predictors of patients’ privacy. Thus, this study aimed to determine the predictive effects of ethical climate and nurses’ spiritual well-being on patients’ privacy in ICU.MethodsIn this analytical cross-sectional study, 250 out of 500 ICU nurses were recruited using proportionate allocation stratified sampling. Data were collected using a demographic characteristics form, Patient Privacy Scale, Hospital Ethical Climate Survey, and Spiritual Well-Being Scale. The data were analyzed using Pearson correlation coefficient and hierarchical linear regression analysis.ResultsThe results showed that patients’ privacy was associated with the hospital’s ethical climate and nurses’ spiritual well-being (P < 0.001). The hierarchical linear regression analysis indicated that, in step 1, patients (β = 0.22, P = 0.03) and managers’ (β = 0.41, P < 0.001) subscales of ethical climate had a significant proportion of the variance of patients’ privacy. In step 2, patients (β = 0.25, P = 0.01), managers’ (β = 0.34, P < 0.001) subscales of ethical climate, and nurses’ spiritual well-being (β = 0.17, P = 0.01) had a significant proportion of the variance of patients’ privacy. According to step 2, these variables explained 40% of the changes in patients’ privacy.ConclusionThe results of the present study showed that the ethical climate and nurses’ spiritual well-being were the predictors of patients’ privacy. Given that 40% of the variance of the patients’ privacy was recognized by these variables, it is suggested that further research should be conducted to determine other predictors.

Objective: The aim of this study was to verify the role of spiritual well-being as a moderator of the effect of living arrangement on depressive state in the elderly.Methods: We conducted a cross-sectional study using semi-structured interviews in Okinawa on 2010. Four hundreds thirteen (165 men, 248 women) participants were asked about 5-item Geriatric Depression Scale (GDS-5) as dependent variable, living arrangements (living alone or living with others) as independent variable, spiritual rating scale for elderly as mediating variable, and demographic and socioeconomic variables as control variables. The main and interaction effects were assessed using hierarchical multiple regression and simple slope analyses..Results: The proportion of elderly who living alone was 26.6% (n=110), and they were significantly higher scores of GDS-5 than the elderly who living with others (P=0.001). Significant negative correlation was found between depressive state and spiritual well-being (r=-0.27, P<0.001), and the result indicated that the elderly with higher spiritual well-being were lower depressive state. Results of hierarchical regression analysis showed that the correlation between living arrangement and spiritual well-being was positively associated with increased risk for depressive state (β=0.10, P=0.037). Simple slope analyses revealed that the elderly who living alone had significantly higher depressive state scores than those who living with others only in low spiritual well-being (P=0.002), but not in high spiritual well-being (P=0.445)..Conclusions: Our findings suggest that spiritual well-being might play an important role in preventing the elderly who living alone from depression, and interventions aimed at promoting spiritual well-being in the elderly who living alone may lead to improvements in mental health.

Relationship between nurses' moral sensitivity and patient safety culture: Cross-sectional study.

BackgroundNurses in long-term care often experience moral distress. While moral distress has been reported to negatively impact nursing competence and patient outcomes, some studies suggest that it may contribute positively to nursing competence. Thus, knowledge regarding the impact of moral distress on nursing competence remains limited and inconsistent.Research aimThis study aimed to identify the mediating effects of moral sensitivity and ethical climate on the relationship between moral distress and nursing competence.Research designThis was a quantitative study with a cross-sectional descriptive correlational design.Participants and research contextA survey was conducted with 175 registered nurses working in long-term care hospitals in Korea. Data were collected in September and October 2023. The survey measured moral distress, moral sensitivity, ethical climate, and nursing competence using the Moral Distress Scale, the Moral Sensitivity Questionnaire, the Hospital Ethical Climate Survey, and an instrument for measuring nursing competence in long-term care hospitals, respectively. The collected data were analyzed using SPSS Statistics version 27.0 and the PROCESS macro program.Ethical considerationThis study was approved by the Institutional Review Board. Informed consent was obtained from participants prior to data collection.FindingsMoral distress did not have a significant direct effect on nursing competence; however, it had a positive impact on nursing competence through the mediation of moral sensitivity and ethical climate. Moral sensitivity and ethical climate demonstrated a dual mediating effect in the relationship between moral distress and nursing competence.ConclusionThe findings of this study provide insights into how moral distress can positively contribute to nursing competence. Ensuring that nurses have high moral sensitivity and that organizations foster a positive ethical climate may help moral distress enhance nursing competence.