Moral Sensitivity, Empathy and Prosocial Behavior: Implications for Humanization of Nursing Care

Association of Teamwork, Moral Sensitivity and Missed Nursing Care in ICU Nurses: A Cross-Sectional Study

AIM

To investigate the correlation between intensive care unit (ICU) nurses' demographic characteristics, teamwork, moral sensitivity and missed nursing care.

BACKGROUND

Teamwork, moral sensitivity and missed nursing care are important health challenges among ICU nurses. Clarifying the relationship between variables is benefit to improve the quality of patients care. Nevertheless, a comprehensive conceptualisation of the relationship between teamwork, moral sensitivity and missed nursing care remains lacking.

DESIGN

A cross-sectional design.

METHODS

This study follows the STROBE checklist. ICU nurses were recruited by two hospitals between November 2023 and January 2024, in Shandong Province, China. The demographic characteristic questionnaire, teamwork perceptions questionnaire, moral sensitivity questionnaire-revised version into Chinese and the Chinese version of the missed nursing care questionnaire were used for investigation. Multiple linear regression was used to clarify the factors affecting missed nursing care. Pearson correlation was used to test the correlation between teamwork, moral sensitivity and missed nursing care.

RESULTS

The level of missed nursing care for ICU nurses was low, with overall mean score of 37.49. Missed nursing care for ICU nurses in the labour dispatch were much higher than nurses with the contract system and personnel agency (p < 0.05). The 12-h shifts of ICU nurses also influenced missed nursing care. Furthermore, teamwork has a positive relationship with moral sensitivity (r = 0.653, p < 0.001).

CONCLUSION

Hospital and nursing managers should pay attention to the clinical sense of belonging of ICU nurses, reasonably set the working shifts, which will help to reduce the occurrence of missed nursing care.

RELEVANCE TO CLINICAL PRACTICE

It is recommended that nursing managers should invest in strategies to enhance nurse teamwork and implement a 12-h shift pattern, which can alleviate moral distress and improve quality of care.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. (The data of this were collected from nurses and not related to patients. They were informed of the research process and precautions, signed informed consent.).

Moral sensitivity of nurses in a university hospital in southern Brazil

OBJECTIVE

to analyze the moral sensitivity of nurses while facing ethical conflicts at the professional practice and verify their association with sociodemographic and labor-related variables.

METHOD

cross-sectional study, carried out with 115 nurses from a university hospital of southern Brazil. The Moral Sensitivity Questionnaire - Brazilian Version was applied from April to May 2023. Descriptive and analytical statistics were used to analyze the data.

RESULTS

the mean of the nurse's total moral sensitivity score was 3.49 (SD=0.36). The lowest score levels of moral sensitivity were related to the constructs "modified autonomy" (2.48; SD=1.08) and "meaning of the moral structure" (3.46; SD=0.66), while the highest levels were associated with the constructs "respect for patient autonomy" (3.90; SD=0.85) and "experiencing moral conflict" (3.59; SD=1.02). The constructs "modified autonomy" and "meaning of moral structure" were statistically significant regarding the association with the number of employment contracts, work shift and weekly hours worked (p=0.045, p=0.034, and p=0.044, respectively).

CONCLUSION

nurses exhibit moderate levels of moral sensitivity, and aspects of work are related to the ability to recognize and act on ethical problems.

The Nexus of Emotional Intelligence, Empathy, and Moral Sensitivity: Enhancing Ethical Nursing Practices in Clinical Settings

Background: Moral sensitivity is crucial for ethical decision-making in nursing, enabling nurses to respond appropriately to ethical dilemmas in clinical settings. Emotional intelligence and empathy have been identified as key factors influencing moral sensitivity. However, limited research examines the interplay between these variables, particularly in nursing practice. Objective: This study explores the relationships between emotional intelligence, nursing empathy, and moral sensitivity among nurses in Mosul teaching hospitals and examines empathy's mediating role in these relationships. Methods: This study employed a descriptive cross-sectional design. It involved 300 nurses from Mosul teaching hospitals in Iraq. Data collection occurred from July 1, 2024, to October 1, 2024. Validated measurement tools were used, including the Emotional Intelligence Scale (EIS), the Jefferson Scale of Empathy, and the Moral Sensitivity Questionnaire. Statistical analyses, including Pearson's correlation, multiple regression, and mediation analysis, were conducted to examine the relationships among emotional intelligence, empathy, and moral sensitivity. Results: Emotional intelligence and nursing empathy were significantly positively correlated with moral sensitivity (r = 0.58 and r = 0.66, respectively; p < 0.01). Multiple regression analysis revealed that both emotional intelligence (β = 0.30, p < 0.01) and nursing empathy (β = 0.52, p < 0.01) significantly predicted moral sensitivity, explaining 39% of the variance. Mediation analysis indicated that empathy partially mediated the relationship between emotional intelligence and moral sensitivity (p < 0.01). Conclusion: This study highlights the significant roles of emotional intelligence and empathy in enhancing nurses' moral sensitivity, with empathy acting as a partial mediator. Interventions that promote emotional intelligence and empathy development in nursing education and clinical practice could improve ethical decision-making and patient care quality. Further research is needed to explore these relationships longitudinally and in diverse healthcare settings.

Investigating the influence of self‑leadership on moral sensitivity in medical students: A comparative study

Most previous studies have focused mainly on the influence of external interventions (such as moral climate, moral education, and training) on students' moral sensitivity. However, few studies have explored the impact of self‑leadership on promoting moral sensitivity. Based on social cognitive theory, this study aimed to explore the relationship between self‑leadership and moral sensitivity among medical college students and compare the differences between medical students and nursing students. This study is a cross-sectional study. A total of 479 medical college students from China were investigated via self‑leadership scale and moral sensitivity scale. Pearson's correlation analysis, Structural Equation Modeling (SEM), and a group comparison test in Mplus 7.4 were conducted. The results showed that self‑leadership has a significant effect on moral sensitivity and major is a significant moderator in this relationship. Specifically, although medical students' moral sensitivity is greater than that of nursing students, the effect of self‑leadership on the moral sensitivity of nursing students is greater than on that of medical students. These results put forwards feasible opportunities for improving the moral sensitivity of medical students, which has important impacts on medical ethics education.

The level of moral sensitivity among nurses: a systematic review and meta-analysis

BACKGROUND

Nurses, the largest frontline healthcare group in the world, experience a high incidence of moral distress. Enhancing moral sensitivity (MS) can effectively alleviate this distress. However, MS levels among nurses have not been clearly defined. Therefore, this study aimed to assess the level of MS among nurses and provide evidence-based insights to improve their moral practices.

METHODS

This review searched multiple databases, including PubMed, Cochrane Library, Embase, Web of Science, CINAHL, Scopus, Medline, China Knowledge Resource Integrated Database, Wanfang Database, VIP Database, Chinese Biomedical Database, Chinese Medical Journal Full Text Database, Google Scholar, and OpenGrey, from inception to December 31, 2024. Two reviewers (Ting Zhao and Shi Chen) independently screened the literature and extracted data. Their quality was assessed using the Joanna Briggs Institute's Critical Appraisal Tool. Data were analyzed using Stata software (version 17.0) to synthesize the mean scores of the moral sensitivity questionnaire (MSQ). Subgroup and meta-regression analysis were performed to identify the sources of heterogeneity, and a sensitivity analysis was conducted to assess the robustness of the results.

RESULTS

A total of 99 studies involving 29,387 nurses were included. The pooled mean score for MS was 4.49 [95% CI (4.29, 4.70)], indicating a moderate level. Meta-regression revealed the assessment instrument, country, and department as potential sources of heterogeneity. The mean scores by country were as follows: China (5.22), Korea (4.82), Iran (4.44), and Turkey (3.28). The scores for the different assessment instruments varied, with the MSQ-revised version (5.46) having the highest scores.

CONCLUSION

Nurses demonstrated moderate MS levels, indicating opportunities for further improvement. This review offers useful insights for nurse managers and educators in shaping strategies to improve moral training.

Understanding the psychosocial burden of living with advanced COPD in context of palliative care: A mixed methods study

People with advanced chronic obstructive pulmonary disease (COPD) face substantial physical and psychosocial challenges influencing their quality of life. This study explored the psychosocial aspects of people with COPD attending palliative care services. Concurrent embedded mixed methods study with 22 individuals was conducted. Data collection involved semi-structured interviews and McGill Quality of Life-Revised and Hospital Anxiety and Depression Scale questionnaires. Findings revealed a negative correlation between quality of life and psychological distress, emphasising that as disease severity increased, so did psychological distress. From interviews emerged three themes: adjustment to living with a debilitating disease, loss of identity and developing lifestyle coping strategies. To conclude, a biopsychosocial perspective to understanding the impact of COPD is essential in identifying mitigating factors which exacerbate disease burden and increase psychological distress of people living with COPD. Implementing a biopsychosocial framework can enhance care by furthering self-management, reducing psychological distress and promoting a person-centred approach.

Profiles of moral sensitivity and their associated factors in nursing students: A latent profile analysis

AIM

This study was conducted to identify group profiles in moral sensitivity among Chinese nursing students and examine the factors associated with moral sensitivity subgroups.

BACKGROUND

Moral sensitivity is a precondition for ethical decision making. Developing this sensitivity equips nursing students with the skills to identify and respond appropriately to ethical dilemmas, which are essential as they prepare to enter clinical settings. As integral members of the future nursing workforce, nursing students must be well prepared to navigate the ethical challenges they face.

DESIGN

This study used a cross-sectional design.

METHODS

Using convenience sampling, 716 nursing undergraduates from three universities in Jiangxi Province participated in this study. Participants completed online assessments of personality traits, empathy, professional nursing values and moral sensitivity. Latent profile analysis was used to identify moral sensitivity profiles and multinomial logistic regression was used to explore factors influencing distinct moral sensitivity profiles in nursing undergraduates.

RESULTS

Results identified three profiles: "moral idealists" (9.7 %; high moral strength, moral burden; low moral responsibility), "moral undertakers" (32.0 %; moderate moral strength, moral burden; high moral responsibility), "moral skeptics" (58.3 %; low moral strength, moral burden and moral responsibility). Multinomial logistic regression analysis showed that grade level, only child status, agreeableness, conscientiousness, emotional stability, empathy and professional nursing values were associated with different profiles of moral sensitivity in nursing students.

CONCLUSION

Most undergraduate nursing students were placed in the moral skeptics group; thus, educational institutions should pay special attention to nursing students with low levels of moral sensitivity. Particular attention and additional support should be given to nursing students who are only children, in their lower academic years, exhibit neurotic traits and possess lower levels of agreeableness and conscientiousness. Educational activities and programs that prioritize empathy and professional nursing values may present a viable approach to fostering moral sensitivity among nursing students.

Development of a novel instrument to measure Japanese psychiatric nurses' technological competency as caring in nursing

Background

To effectively advance person-centered care (PCC) practice, it is important to equip healthcare providers with person-centered values and beliefs while simultaneously transforming their work environment to align with PCC. Thus, instruments to measure caring practice status in nursing competency for psychiatric-specific behavioral limitations, ethico-moral behavior, technology use, and PCC need to be developed.

Objective

This study developed the Technological Competency as Caring in Psychiatric Nursing Instrument (TCCNPNI) to measure practice status and test its content and construct validity.

Methods

Five different phases were followed: 1) Literature Review; 2) Operational definition of the construct and development of items; 3) Two-round Delphi method; 4) Validity measure; and 5) Reliability measure. The online survey was conducted in 2024.

Results

The developed instrument comprises 22 items with a 4-factor structure: competency to practice caring and person-centered care (Factor 1); competency to recognize and respond to ethical issues in psychiatry (Factor 2); competency to utilize technology in psychiatry (Factor 3); and competence to practice care for the preservation of human dignity and shared decision making (Factor 4). Cronbach's alpha for the entire scale was 0.864, while that for factors 1-4 was 0.911, 0.814, 0.773, and 0.64, respectively. Cumulatively, these four factors contributed 49.6% and explained nearly 50% of the total data. Item-total correlation values were 0.6 or higher among factors 1-3. However, factor 4, for which items were Q30, Q33, Q34, and Q35 (r = 0.03, 0.04, 0.21, 0.11, respectively), were inverted items and had low I-T correlation values. These low correlations suggest that these items capture different concepts. The developed TCCNPNI allows for the measurement of the practice of nursing as caring in psychiatry, the state of ethico-moral behavior, and the practice status of technological competency as caring in psychiatric nursing.

Conclusion

This study demonstrated satisfactorily and efficiently evaluated the practice status of technological competency in psychiatric nurses' caring. Measuring technological competency as caring in psychiatric nursing can be an important adjunct for in-service education in psychiatric hospitals or formalized nursing education in nursing universities.

The effects of community-based education programs on empathy, emotional intelligence, and caring behaviors among nursing students: a scoping review

Introduction

Community-based learning approaches are gaining recognition in nursing education as a means to address the needs of aging societies by fostering empathy, emotional intelligence, and caring behaviors among nursing students. These attributes are essential for enhancing the quality of care and building strong interpersonal connections with older adults. While community-based education programs offer promising benefits, there is still limited understanding of their impact on nursing students' empathy, emotional intelligence, and caring behaviors. This scoping review aims to examine how community-based educational interventions can assist nursing students in developing these essential competencies, ultimately contributing to better outcomes in geriatric care.

Method

A scoping review was conducted following the framework of Arksey and O'Malley. The following electronic databases were searched: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Web of Science, Psychology and Behavioral Sciences Collection, PubMed, and Google Scholar. Gray literature was also searched through Google Scholar and ProQuest. Studies included reports on nursing students' emotional changes due to educational engagements with older adults.

Results

A total of 3,001 abstracts were screened, with 78 full texts reviewed, resulting in 9 studies being included in the analysis. The results demonstrate that interactions with older adults enhance nursing students' empathy and emotional intelligence while fostering positive changes in their caring behaviors. Participants reported greater sensitivity to the feelings and physical discomforts of older adults, contributing to improved care and stronger relational dynamics.

Discussion

Community-based education programs involving older adults represent an effective strategy for enhancing nursing students' empathy, emotional intelligence, and caring behaviors, suggesting valuable implications for nursing education methodologies.

Empathy, Moral Sensitivity, and Prosocial Behavior Among Medical Undergraduates in a South Indian Tertiary Care Teaching Institute: An Analytical Cross-Sectional Study

INTRODUCTION

 Empathy, moral sensitivity, and prosocialness are critical traits for medical professionals, as they affect patient care quality and ethical decision-making. These traits help address psychological complexities like stress and burnout in medical practice. Despite their importance, the relationships between these traits, especially among medical students, remain underexplored. This study aims to assess empathy, moral sensitivity, and prosocialness among medical students in South India, focusing on gender differences and their associations.

MATERIALS AND METHODS

 This cross-sectional study was conducted at Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, with 369 medical undergraduates. Data were collected using three standardized tools: the Interpersonal Reactivity Index for empathy, the Moral Sensitivity Questionnaire, and the Prosocialness Scale for Adults. The questionnaire, including demographic data, was administered online with anonymity and consent. Descriptive statistics summarized demographic data. Inferential analyses, including t-tests, chi-square tests, Pearson correlations, and multivariate regression, examined relationships between empathy, moral sensitivity, pro-social behavior, and demographics. Statistical significance was set at p < 0.05. Ethical approval was obtained from Saveetha Medical College's Ethics Committee.

RESULTS

 The mean age of participants was 20.5 ± 2 years, with 183 males (49.6%) and 186 females (50.4%). The majority were first-year students (29.8%), followed by second-year (19.5%) and final-year part I students (19.2%). Final professional part II students and interns comprised 15.4% and 16%, respectively. Females scored significantly higher in empathy domains like perspective-taking (15 ± 3.3 vs. 14 ± 3.4), fantasy (14.4 ± 4 vs. 13.6 ± 3.3), and empathetic concern (15.3 ± 3.5 vs. 14.2 ± 3.1), with p values <0.05. Overall, 186 females (50.4%) had a mean empathy score of 59 ± 9, compared to 183 males (49.6%) with 56.2 ± 7.1 (Cohen's d = 0.33). In moral sensitivity, females scored higher in modifying autonomy (7 ± 2.3 vs. 6.3 ± 2.2), structuring moral meaning (4.6 ± 2 vs. 4.15 ± 1.6), and expressing benevolence (16 ± 4 vs. 15 ± 4), with significant differences (p < 0.05). The total moral sensitivity score was higher in females (57 ± 10 vs. 54 ± 9), with a moderate effect size (Cohen's d = 0.3). Males scored higher in prosocialness, with 183 males (49.6%) scoring 54 ± 7, compared to 186 females (50.4%) with 51.5 ± 7.2 (Cohen's d = 0.3). Weak but significant correlations were found between empathy and prosocialness (r = 0.132, p = 0.011) and between moral sensitivity and prosocialness (r = 0.479, p < 0.001). Regression analysis identified gender, prosocial behavior, and specific moral sensitivity dimensions as significant predictors of empathy scores.

CONCLUSION

 This study revealed significant gender differences in empathy, moral sensitivity, and prosocialness among medical students. Females scored higher in empathy and moral sensitivity, whereas males showed greater prosocial behavior. The positive correlations between empathy and prosocialness and between moral sensitivity and prosocialness highlight their interconnectedness. Educational interventions that target empathy and moral sensitivity could help nurture more compassionate, ethical healthcare professionals. Future research should explore how these traits evolve throughout medical education.

Is there a relationship between nurses' hand hygiene beliefs, practices and ethical sensitivity?

BACKGROUND

Hand hygiene is the most important way to prevent health care-associated infections. It is important for all nurses that come in physical contact with patients the most to follow hand hygiene rules.

AIM

This study aimed to determine the relationship between nurses' hand hygiene beliefs and practices and their ethical sensitivity.

METHOD

This descriptive and cross-sectional study was conducted with nurses working in internal medicine, surgery and intensive care clinics of a university hospital between June and August 2022. A total of 350 nurses participated in the study. A Personal Information Form, the Ethical Sensitivity Questionnaire (ESQ), the Hand Hygiene Practice Inventory (HHPI), and the Hand Hygiene Beliefs Scale (HHBS) were used for data collection.

RESULTS

Findings support that nurses have moderate ethical sensitivity (88.36 ± 26.33), good hand hygiene beliefs (85.60 ± 9.21) and practice (66.14 ± 5.90). Despite there being no statistical significance in evaluating the relationship between hand hygiene practice and ethical sensitivity (p = 0.253, r = -0.061), there was a statically significant inverse relationship between hand hygiene beliefs and ethical sensitivity (p = 0.001, r = -0.172). The hand hygiene compliance score of the nurses who received only ethics training after nursing school (p = 0.000); the hand hygiene belief (p = 0.011) and hand hygiene practice (p = 0.007) scores of those who received both ethics and hand hygiene training were higher.

CONCLUSIONS

It can be said that the ethical sensitivity of nurses does not affect their hand hygiene practices, and the hand hygiene and ethics education they receive after school education increases their hand hygiene beliefs and practices.

Effects of Standardized Patient Simulation and Mobile Applications on Nursing Students' Clinical Competence, Self-Efficacy, and Cultural Competence: A Quasi-Experimental Study

BACKGROUND

Simulation-based education has emerged as an effective approach in nursing education worldwide. We aimed to evaluate the effectiveness of a surgical nursing education program based on a simulation using standardized patients and mobile applications among nursing students.

METHODS

A mixed-methods design with a quasi-experimental longitudinal approach and focus group interviews was employed. The data were collected from 130 third-year nursing students at three different time points who were equally divided into experimental and control groups. This study measured the level of clinical surgical nursing competence, self-efficacy in clinical performance, cultural competence, and satisfaction with simulation experience. Four focus group interviews were conducted using open-ended questions to explore the participants' perspectives on the course's efficacy and satisfaction.

RESULTS

There were statistically significant differences in clinical surgical nursing competence (F = 8.68, p < 0.001), self-efficacy in clinical performance (F = 13.56, p < 0.001), and cultural competence (F = 10.35, p < 0.001) across time between the intervention and control groups. Student satisfaction with the simulation-based training was high, particularly regarding debriefing and reflection, with an overall mean satisfaction level of 4.25 (0.40). Students' perspectives regarding integrated hybrid training are categorized into three themes: educational achievement, dynamic learning experiences, and satisfaction and suggestion.

CONCLUSION

Simulation-based learning provides a dynamic and immersive educational experience that enables undergraduate nursing students to develop and refine essential clinical skills while also fostering confidence and cultural competence.

Validation of the Basic Empathy Scale in an Arabic-speaking population: The BES-Ar

PURPOSE

The aim of this work was to test the psychometric properties of the Arabic version of the BES (Basic Empathy Scale) by establishing its factor structure, its internal consistency and construct validity in the general population.

DESIGN AND METHODS

The BES was tested among 526 Tunisian adults.

FINDINGS

The two-factor structure of the BES-20 was confirmed. Internal consistency and concurrent validity were very satisfactory.

DISCUSSION

This scale will be useful for clinicians in various fields (mental health, psychiatry) in Arabic countries.

Medical students' perceptions of prosocial behaviors: a grounded theory study in China

INTRODUCTION

Prosocial behavior has been shown to be protective against burnout. Yet, we know little about prosocial behavior in medical students. We wanted to know what are chinese medical students' understanding of prosocial behavior and which factors influence their participation in it?

METHODS

We undertook a grounded theory study, following Corbin & Strauss. We used convenience sampling and conducted semi-structured individual interviews. We analyzed data using open, axial, and selective coding techniques. Next, we grouped data into concepts. We noticed these concepts aligned with three existing social theories, so we developed our theory in concert with these: the Theory of Planned Behavior, Self-Determination Theory, and Social Support Theory.

RESULTS

Twenty-eight medical students participated in this study. Medical students hold especial views on the roles of medical physicians, and most of these views align with students' core values, including the value of prosocial behavior. Students are intrinsically motivated to engage in prosocial behaviors that align with their core values. Personal values, personality traits, perceived self-competence, career motivation, environmental factors, and family influences are the core factors influencing medically positive prosocial behavior.

CONCLUSIONS

This study supports a focus on prosocial behavior instead of altruistic behavior in medical education. We anticipate that promoting prosocial behavior through medical curricula will reduce moral distress and burnout among medical students.

Pharmacists' Attitudes towards Medically Assisted Dying

AIMS

We aimed to explore pharmacists' attitudes and support toward medically assisted dying (MaiD) through the End of Life Choice Act 2019 (EOLC), their willingness to provide services in this area of practice, and the influences on their decisions.

METHODS

The study was conducted via an anonymous, online QualtricsTM survey of pharmacists. Registered New Zealand pharmacists who agreed to receive surveys from the two Schools of Pharmacy as part of their Annual Practicing Certificate renewal were invited to participate through an email with a Qualtrics URL link. The survey contained questions regarding demographics, awareness, knowledge, support for, and attitudes and willingness to participate.

RESULTS

Of the 335 responses received, 289 were valid and included in the analysis. Most participants supported legally assisted medical dying (58%), almost a third of participants did not support it (29%), and 13% of respondents were unsure. The five primary considerations that participants perceived to be beneficial included support from legislation, respect for patient autonomy, discussions around morality, ending suffering, and preserving dignity. The main concerns were legal, personal bias, palliation, stigmatisation, and vulnerability.

CONCLUSIONS

The influences on the decision by pharmacists to support and willingness to participate in the provision of services consistent with the EOLC are complex and multifactorial. Diverse factors may influence attitudes, of which religion is the most significant factor in not supporting the Act or willingness to participate. Clarity and standardised guidance to ensure that assisted dying queries are appropriately managed in practice would help to address any potential access issues.

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.

Effect of moral sensitivity on professional values of undergraduate nursing students: Mediating effect of empathic tendency

BACKGROUND

The development of professional values in nursing students is an important issue for the nursing profession. However, the research on nursing students' professional values and its related factors is very limited.

PURPOSE

This cross-sectional and correlational study aimed to examine the mediating effect of empathy between moral sensitivity and professional values.

METHODS

This study was conducted with 328 second, third and fourth-year students. The participants completed an online survey consisting of the student information form, Modified Moral Sensitivity Questionnaire for Student Nurses, Empathic Tendency Scale and Nursing Professional Values Scale.

RESULTS

The results showed that moral sensitivity affected undergraduate nursing students' professional values not only directly but also indirectly through empathic tendency.

CONCLUSIONS

The results of the study show that moral sensitivity and empathic tendency support the acquisition of professional values in undergraduate nursing students. Nurse educators needs to realize that can be improved professional values by integrating moral sensitivity and empathic tendency in their curriculum.

Positive impacts of perceived social support on prosocial behavior: the chain mediating role of moral identity and moral sensitivity

The relationship between mental health and perceived social support has been well-established in previous studies. While previous research indicates that perceived social support is related to prosocial behavior, the mechanisms underlying this relationship remain unclear. In order to address this gap, a recent study investigated the mediating effects of moral identity and moral sensitivity on the relationship between perceived social support and prosocial behavior. Specifically, the study surveyed 978 college students using a questionnaire to examine the relationship between these variables. The results of the study showed that, after controlling for gender and age, perceived social support, moral identity, and moral sensitivity were significantly and positively correlated, all of which were also significantly and positively related to prosocial behavior. In addition, the study found that perceived social support was able to influence prosocial behavior through both independent mediation by moral identity and moral sensitivity, as well as through chain mediation. The findings of this study contribute to our understanding of the factors that shape prosocial behavior and offer suggestions for promoting such behavior in individuals.

Is there any relationship between nurses' perceived organizational justice, moral sensitivity, moral courage, moral distress and burnout?

AIM

The present study is an attempt to investigate the relationship between Corley's model variables in mental health nurses.

BACKGROUND

Based on Corley's model, burnout and moral distress in nurses are, in retrospect, the consequences of the interplay of organizational and individual factors such as perceived organizational justice, moral sensitivity, and moral courage. The relationship between two variables or three variables of Corley's moral distress model has been investigated, but the test of Corley's moral distress model with more variables has not been done. Therefore, this research was proposed with the aim of investigating the relationship between the variables of moral courage and moral sensitivity (as characteristics of nurses), perceived organizational justice (as an antecedent), moral distress, and job burnout (as consequences of moral distress).

METHODS

The study was conducted as a descriptive correlational study involving 500 nurses working in the mental health wards of hospitals. Data collection was conducted using perceived organizational justice scale, moral sensitivity scale, moral courage scale, moral distress scale, and burnout inventory.

RESULTS

The results showed a significant relationship between perceived organizational justice, moral sensitivity, moral courage, and moral distress (< 0.05). Moreover, perceived organizational justice and moral distress had an inverse relationship. Moral sensitivity and moral courage had a direct relationship with moral distress (< 0.05). Furthermore, the results showed inadequate model fitness.

CONCLUSIONS

This study adds to the existing knowledge about the experiences of mental health nurses and their interactions with both organizational and individual factors. It highlights that the connections between perceived organizational justice, moral sensitivity, moral courage, moral distress, and burnout are intricate and multifaceted. As we deepen our understanding of these relationships, it opens the door for the development of interventions and strategies to enhance nurses' well-being and the quality of care they deliver in mental health settings. Moreover, future research and ongoing refinement and expansion of Corley's model will be crucial in addressing the complex challenges within the healthcare sector.

Bidirectional relations between guilt/shame and moral sensitivity: a two-wave cross-lagged analysis

Emotions, particularly social moral emotions, are believed to play a critically important role in moral development. Although it is of great theoretical and practical significance to improve individual morality, especially moral sensitivity, from the perspective of moral emotion, little attention has been paid to investigating the causal mechanisms between moral emotions and moral sensitivity. Therefore, through a longitudinal study, the current study explored the causal relationship between moral sensitivity and the typical moral emotions (guilt and shame) from empathy theory and cognitive appraisal theory of emotions. A total of 668 adolescents completed the two-wave survey over two years. We explored the causal association between moral emotions and moral sensitivity using the structural equation model. The cross-lagged analysis showed a reciprocal relationship between guilt and moral sensitivity, whereas shame did not have a unidirectional or bidirectional predictive relationship with moral sensitivity. This is the first research that reveals the significance of guilt as a moral emotion to enhance moral sensitivity. The finding offered a new practical and theoretical viewpoint for promoting individual moral development from the perspective of social moral emotional cultivation.

Working nurses' empathy with patients in public hospitals

OBJECTIVE

to determine the levels of empathy in professional nurses of a high-complexity hospital, to relate age to empathy (and each one of its dimensions), and to establish if there are differences between these levels according to the type of working schedules.

METHOD

comparative, correlational and cross-sectional design. The sample used (n=271) constituted 40.9% of the total number of nursing professionals. Psychometric properties of the Jefferson Scale of Empathy for Health Professionals were studied. Descriptive statistics were calculated: mean and standard deviation. The association between empathy and age was estimated using regression equations and statistical significance of the regression coefficients, after evaluating the type of curve using variance analysis.

RESULTS

the underlying model of three dimensions of empathy was identified. The values of the descriptive statistics observed were relatively low in empathy and its dimensions. Empathy levels were not associated with the age range. No differences in empathy were found between the types of work schedules. Variability was found in the dimensions: "compassionate care" and "Walking on the patient's shoes".

CONCLUSION

these results show that the levels of empathy observed may imply a deficient performance in empathetic care for patients. (1) The levels of empathy are low in the nursing professionals studied. (2) These levels are not associated with age and type of work performed. (3) Low levels of empathy could imply a negative alteration of humanized attention.

Midwife empathy and its association with the childbirth experience: a cross-sectional study

BACKGROUND

Although pregnancy and childbirth comprise a life-course that most midwives experience, whether their own experiences of childbirth resonate with other women during childbirth remains to be determined. In this study, we therefore characterized midwives' empathic capabilities and defined their underlying factors.

METHOD

We conducted a cross-sectional study with data from 464 midwives in Guangdong, China, that were collected through the "Chinese version of the Jefferson Scale of Empathy for Health Professionals (JSE-HP)." This questionnaire contains sections related to midwife demographics and delivery characteristics. We then implemented multivariate logistic regression analysis to identify empathy-related factors.

RESULTS

Our analysis revealed 303 (65.3%) participants in the high-empathy group while 161 (34.7%) were in the middle-empathy group. Compared with the reference groups, these results indicated that higher empathy was associated with an elevated educational level (OR, 1.83; 95% CI, 1.04-3.25), high monthly salary (OR, 2.30; 95% CI, 1.11-4.80), and no shift work (OR, 2.89; 95% CI, 1.09-7.63). The odds of a high empathy score were higher for midwives who experienced two childbirths (2.27, 1.11-4.66) and for those who had children under the age of 3 years (2.81, 1.34-5.92).

CONCLUSION

Midwives possess a moderate-to-high level of empathy, and the greater the number of childbirths they experienced and the younger their children, the higher their reported empathy score. This study contributes novel information regarding the empathic behavior of midwives toward women who give birth in China.

The Mechanism of Cumulative Ecological Risk Affecting College Students' Sense of Social Responsibility: The Double Fugue Effect of Belief in a Just World and Empathy

According to bioecological theory, the development of college students' social responsibility is affected by the cumulative effect of ecological risks. However, research on the impact of cumulative ecological risk on social responsibility and its potential mechanisms are still lacking. Carol Gilligan (1982) proposed that the ethics of care and justice are like two related but independent melodies, which together constitute the whole of moral psychology. However, despite being an important part of moral psychology, social responsibility has rarely been investigated empirically with regards to the psychological mechanisms of justice and caring orientation. Therefore, the current study had 1607 college students complete questionnaires regarding cumulative ecological risk, social responsibility, belief in a just world, and empathy, aiming to explore the impact of cumulative ecological risk on college students' sense of social responsibility and the mediating roles of belief in a just world and empathy. Results showed that: (1) cumulative ecological risk was significantly negatively correlated with college students' sense of social responsibility, belief in a just world, and empathy, whereas social responsibility, belief in a just world, and empathy were significantly positively correlated; (2) belief in a just world and empathy played mediating roles in the relationship between cumulative ecological risk and social responsibility. The results also showed that the development of college students' sense of social responsibility was affected by the cumulative ecological risk from various directions; this influence was also seen to play a role in the motivation system of social responsibility through the ethics of care with empathy as the important part, as well as through the ethics of justice. The results suggest that we should reduce the ecological risks at their source, and improve and consolidate students' social support systems; moreover, we should not only enhance college students' sense of mission and responsibility to consciously maintain social justice order, but also adopt empathy training as a part of the curriculum to improve students' empathy at the individual level.

Nursing students' motivational and self-regulated learning during the COVID-19 pandemic: A cross-sectional study

On‐site clinical training, which has been greatly hindered during the COVID‐19 pandemic, is essential in nursing practicum. This study aimed to identify the predictors of nursing students' motivational and self‐regulated learning in clinical nursing practicum during the pandemic. This cross‐sectional study aimed to identify the predictors of motivational and self‐regulated learning among nursing students in clinical nursing practicum during the COVID‐19 pandemic. An online survey was completed by 195 nursing students in Korea in 2021. Students' moral sensitivity and motivational and self‐regulated learning were assessed using the Moral Sensitivity Questionnaire and the Motivated Strategies for Learning Questionnaire. Multiple regression analysis revealed that moral sensitivity was the most potent predictor of motivational and self‐regulated learning, followed by online clinical practicum experience, determination to become a nurse, and online practicum type; these factors explained 21.0% of the variance. Practicum courses using a tailored hybrid model, combining online and in‐person approaches for imparting nursing practices and inspiring moral sensitivity, can enhance nursing students' motivational and self‐regulated learning. Modules to enhance nursing students' moral sensitivity should be included in online practicum curricula.

Mindfulness, empathy and moral sensitivity in nurses: a structural equation modeling analysis

Background

Ethical issues may pose challenges to nurses; moral sensitivity can help them to overcome these challenges. Identifying variables related to moral sensitivity can help in planning to increase nurses’ moral sensitivity. This study aimed to investigate the relationship among mindfulness, empathy, and moral sensitivity in a sample of nurses.

Methods

In the present study, a cross-sectional design utilizing Structural Equation Modeling (SEM) was conducted. The nurses in a private hospital in Yazd, Iran, were invited to participate in the study (n=162) using simple random sampling. In order to gather the data, the Freiburg’s mindfulness inventory, moral sensitivity questionnaire, and revised Jefferson’s empathy scale were used. The hypothesized model was analyzed by SEM.

Results

The results show that Mindfulness (β=0.41, t=5.53, p<0.01) and empathy (β=0.52, t=6.77, p<0.01) had a significant direct effect on moral sensitivity. However, mindfulness had an indirect effect on nurses’ moral sensitivity via empathy improvement (z= 6.25, p<.01).

Conclusion

Empathy played a significant mediating role in the relationship between mindfulness and moral sensitivity, so mindfulness-based interventions with an emphasis on empathy may provide an opportunity to increase moral sensitivity in nurses.

Structural Equation Modeling of Person-Centered Nursing in Hospital Nurses

Background: This study aimed to develop and test a model of person-centered nursing (PCN) for hospital nurses using Structural Equation Modeling (SEM). Methods: This was a cross-sectional descriptive study. The subjects of this study were 340 clinical nurses in South Korea. A survey was conducted using an online questionnaire. Data were analyzed using SPSS 18.0 and AMOS 21.0. Results: Results of the validity test of the hypothesized model showed that goodness-of-fit indices satisfied the criteria (χ2 = 573.767 (df = 257, p < 0.001), TLI = 0.92, CFI = 0.93, SRMR = 0.02, RMSEA = 0.06), and 10 of the 15 paths established in the hypothesized model were statistically supported. The model’s explanatory power was 82%, which showed that empathy directly and indirectly affected PCN, and that nursing competency directly affected clinical nurse performance of PCN. In addition, nursing competency, interpersonal relationship ability, and moral sensitivity indirectly influenced PCN through empathy. Conclusions: In order to promote PCN for clinical nurses, it is desirable to develop in-hospital education programs that can improve nursing competency, interpersonal relationship ability, and moral sensitivities, emphasizing elements of empathy. Empathy was an important mediating factor that influenced the relationships between PCN and related variables.

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.

Hospital nurses' empathy and moral sensitivity toward elderly care: A cross-sectional study

AIM

The aim of this study is to explore factors that influence elderly caring attitudes, with a focus on empathy and moral sensitivity.

BACKGROUND

Medical and nursing needs of the elderly have escalated as a consequence of changes induced by aging and the associated diseases and disabilities.

METHOD

A cross-sectional study involving 229 nurses from four general hospitals in South Korea was conducted. Questionnaires assessing demographic and work experience information, empathy (Empathy Construct Rating Scale), moral sensitivity (Korean version of the Moral Sensitivity Questionnaire) and elderly caring (Elderly Caring Attitude Scale) were used. Data were analysed using multiple regression analysis.

RESULTS

The factors influencing the caring attitudes of nurses were empathy, moral sensitivity, preference for geriatric nursing and experience with continuing education in geriatric nursing. The explanatory power of this regression model was 59.4%.

CONCLUSIONS

Strategies to enhance empathy and moral sensitivity of nurses and education related to geriatric nursing might help improve elderly caring attitudes.

IMPLICATIONS FOR NURSING MANAGEMENT

Continued education in geriatric nursing should be provided for nurses caring for the elderly. In terms of nursing management and education, it is necessary to consider and develop strategies to improve the empathy and moral sensitivity of nurses toward elderly patients.