Moral Sensitivity and Emotional Intelligence in Intensive Care Unit Nurses

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.).

The impact of emotional intelligence on work performance among ICU nurses in Palestine: a cross-sectional study

BACKGROUND

Emotional intelligence plays a crucial role in work performance, especially in high-stress ICU settings. Understanding emotional intelligence's role can inform targeted interventions to support nurse well-being, enhance resilience, and improve patient outcomes.

METHODS

This descriptive cross-sectional study involved 226 ICU nurses in Palestine, recruited through a convenience sampling method. Data were collected using self-administered questionnaires, including the Schutte Emotional Intelligence Test and a job performance scale. Descriptive statistics, correlation analyses, and regression models were used to analyze predictors of job performance.

RESULTS

The study included 226 nurses, mostly male (74.3%), aged 21-30 years (71.2%), with a bachelor's degree (68.1%) and less than five years of ICU experience (59.3%). Emotional intelligence scores were high, with an average of 151.9 ± 1.9, and perception of emotions had the highest subscale score. Work performance was also high, averaging 4.3 ± 0.7, with job quality and job quantity scoring the highest. A strong positive correlation (r = 0.611, P < 0.05) was found between EI and work performance. EI and educational level were significant predictors of work performance (β = 0.123, p < 0.01), explaining 39.3% of the variance.

CONCLUSION

the study highlights the critical role of emotional intelligence in improving ICU nurses' work performance, particularly in job quality and quantity. Higher emotional intelligence helps nurses meet ICU demands, while educational level serves as a key predictor of performance. These findings highlight the need for EI training in nursing education, professional development, and workplace policies. Structured programs can enhance nurses' decision-making, communication, and stress management, ultimately improving performance, patient care quality, and safety. Future research should adopt longitudinal or experimental designs to establish causality and evaluate the impact of EI training on nursing performance.

CLINICAL TRIAL NUMBER

Not applicable.

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.

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.

Moral sensitivity in Iranian nurses: insights from a nationwide meta-analysis

BACKGROUND

Moral sensitivity is essential for nurses to recognize and appropriately respond to ethical issues, understanding the impact of their actions on patient well-being. It improves care quality, ethical decision-making, and equips nurses with skills to handle moral dilemmas in clinical settings. Various studies in Iran have reported different results. Accordingly, this study was conducted to estimate the pooled standardized moral sensitivity score among Iranian nurses.

METHODS

A systematic search of national and international databases was conducted up until June 2023, yielding 563 articles. After screening by two independent researchers, 52 articles with a total sample size of 11,621 participants were included in the analysis. Any discrepancies were resolved through discussion. Heterogeneity was assessed using the I² index. Subgroup analyses were performed based on the language of the articles, sample size, and country region. Meta-regression analysis was conducted to explore the relationship between the moral sensitivity score and variables such as age, year of publication, and sample size. All analyses were performed using Stata software, version 17.

RESULTS

The pooled moral sensitivity score was 69% (95% CI: 66-72, I2 = 94.03%). The highest overall ethical sensitivity score was observed in region 5 of the country (73.6%, 95% CI: 67-80.1), in articles published in Farsi (70.2%, 95% CI: 65.8-74.7), and in articles with a sample size of less than 200 participants (70%, 95% CI: 66.3-73.6). No significant relationship was found between the overall ethical sensitivity score and variables such as age, year of publication, or sample size. Publication bias was significant (p = 0.001).

CONCLUSION

This meta-analysis indicates a moderate level of moral sensitivity among Iranian nurses. While regional and study-related differences were observed, no significant relationship was found between the moral sensitivity score and variables like age, year of publication, or sample size. Publication bias suggests the need for more representative studies to fully understand the factors influencing moral sensitivity in nursing.

CLINICAL TRIAL NUMBER

This study is a systematic review and meta-analysis, and not a clinical trial.

Post-traumatic growth, moral sensitivity and service behaviour among healthcare workers in the post-pandemic era of COVID-19 in mainland China: a cross-sectional study

OBJECTIVES

To investigate how post-traumatic growth (PTG) and moral sensitivity influence service behaviour among healthcare workers (HCWs) in mainland China post-COVID-19, with a focus on the mediating role of moral sensitivity.

DESIGN

Cross- sectional survey design.

SETTING

This study was conducted in 27 provinces across mainland China, from 16 March to 2 April 2023.

PARTICIPANTS

1,193 HCWs, including 378 physicians and 815 nurses, were selected using convenience and snowball sampling methods.

METHODS

The survey included the Post-traumatic Growth Inventory-Chinese version (PTGI-C), the Moral Sensitivity Questionnaire-Revised Chinese Version (MSQ-R-CV) and a service behaviour scale. Structural equation modelling was employed to analyse the data, focusing on the associations between PTG, moral sensitivity, and service behaviours.

RESULTS

The study found significant associations between PTG and moral sensitivity (r=0.49, p<0.01), with both factors positively influencing HCWs' service behaviours. Specifically, PTG had a direct effect on service behaviours (β=0.172, p<0.01) and an indirect effect through moral sensitivity (β=0.333, p<0.01), with moral sensitivity mediating 65.8% of PTG's impact on service behaviours. The model explained 56.0% of the variance in service behaviours, indicating a substantial influence of these psychological factors on professional conduct.

CONCLUSIONS

The findings highlight the significant role of PTG and moral sensitivity in shaping the service behaviours of HCWs in the aftermath of the COVID-19 pandemic. The study suggests that enhancing PTG and moral sensitivity through targeted interventions could improve HCWs' service delivery and resilience, emphasising the importance of incorporating psychological and ethical training into healthcare practices to prepare for future public health crises.

Moral sensitivity as a personal and work attribute of emergency care nurses: a cross-sectional study

OBJECTIVE

to analyze the moral sensitivity of Brazilian emergency care nurses according to their personal and work characteristics.

METHOD

this is a quantitative, descriptive, cross-sectional study with a convenience sample. A total of 422 nurses from emergency care services in the five regions of Brazil took part. Sociodemographic and work-related information was collected, as well as the Brazilian version of the Moral Sensitivity Questionnaire. After approval by the Research Ethics Committee, the data was collected using a self-administered form on the Google Forms Platform, organized using Excel software and analyzed using the R language.

RESULTS

nurses with longer experience in emergency care services showed higher levels in the interpersonal orientation, moral conflict and moral significance dimensions, while in the professional knowledge dimension, men showed higher levels, as evidenced by items that include confidence in nursing knowledge, intuition, experience and opinion.

CONCLUSION

the differences in the nurses' moral sensitivity were due to their professional experience. It should be emphasized that valuing the sharing of intergenerational experiences in service could be a possible strategy for fostering moral competencies in the field of practice.

The Relationship Between Moral Sensitivity, Missed Nursing Care and Moral Distress Among New Nurses: A Cross-Sectional Study

Moral sensitivity, missed nursing care and moral distress among healthcare professionals have received considerable attention in recent years. These factors represent important healthcare challenges for new nurses (graduation to 2 years of work experience). However, studies on the relationships among these variables in the context of new nurses in China remain lacking.

AIMS

To explore the relationships among moral sensitivity, missed nursing care and moral distress in the context of new nurses in China.

RESEARCH DESIGN

A cross-sectional descriptive survey was conducted.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 228 new nurses were recruited from three tertiary hospitals in Qingdao, Shandong Province, China. Participants provided their sociodemographic and professional information and completed the Chinese Moral Sensitivity Questionnaire-Revised Version, the Chinese Missed Nursing Care Survey Version and the Chinese Moral Distress Scale-Revised Version. The data were analysed using Spearman's correlation analysis and multiple linear regression analysis.

RESULTS

The means and standard errors of moral sensitivity, missed nursing care and moral distress were 40.71 (0.39), 9.82 (0.78) and 34.87 (2.41), respectively. The variable of missed nursing care exhibited a significant negative relationship with moral sensitivity and a significant positive relationship with moral distress. Regression analysis revealed that the main factors influencing new nurses' moral distress were educational background, nature of job, current unit, frequency of night shifts and the dimensions of moral strength and responsibility. These factors can explain 14.9% of the total variation.

CONCLUSION

The findings revealed that higher rates of missed nursing care were associated with lower moral sensitivity and greater moral distress among new nurses. Therefore, developing interventions to reduce missed nursing care may be a promising strategy for improving moral sensitivity and preventing moral distress among new nurses.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

In hospitals, moral distress can be improved by focusing on modifiable factors such as staffing resources, leading to better promoting new nurses' health and improving the quality of care. This study can highlight practices accounting for moral sensitivity and missed nursing care in nursing research and training programmes.

REPORTING METHOD

Strengthening the reporting of observational studies in epidemiology (STROBE) statement.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Thirty years of emotional intelligence: A scoping review of emotional intelligence training programme among nurses

The stressful environment of any healthcare setting can be detrimental to nurses' mental and emotional health. In recent years, emotional intelligence (EI) has emerged as a vital psychological resource that positively impacts mental and emotional health and improves organizational functioning and success. This scoping review aimed to collate, synthesize and outline the research conducted on EI training programmes among nurses to assess their effectiveness in improving staff nurses' EI. Electronic databases of MEDLINE via PubMed, CINAHL, Scopus, Cochrane, ProQuest, Embase and Web of Science were comprehensively searched for related studies published between 1990 and 2021 (updated in May 2022). Two investigators independently screened the abstracts of the retrieved studies against the inclusion and exclusion criteria. Out of 728 initially retrieved studies, only 7 were included in the final synthesis. The PRISMA-ScR (2018) checklist was used to report the study findings. All the studies included in the review reported a significant improvement in nurses' EI after a training programme. The results also indicate that EI interventions are an effective way to improve nurses' psychological resources (improve resilience and coping skills; reduce anxiety and stress), leadership qualities, job performance and patient experience of nursing care. As nurses are exposed to a wide range of emotions, human pain and suffering, the results of this review suggest that improving the EI skills of nurses through short training programmes is an effective way to maintain their emotional and mental well-being. This scoping review is preregistered in Prospero (CRD42020161084).

Effect of empathy competence on moral sensitivity in Chinese student nurses: the mediating role of emotional intelligence

BACKGROUND

Ethical issues may pose challenges to nursing students entering clinical practice. Moral sensitivity can assist them in recognising existing moral situations and then taking adequate action. Identifying the variables associated with moral sensitivity may be useful in preparing to improve nursing students' moral sensitivity.

OBJECTIVES

This study investigated empathy, emotional intelligence, and moral sensitivity in Chinese student nurses to explore the association among these three factors and to verify the mediating function of emotional intelligence in determining the connection between empathy and moral sensitivity.

DESIGN

This study used a cross-sectional correlational design.

SETTING AND PARTICIPANTS

Through convenience sampling, 239 fourth-year nursing undergraduates at a university in Western China were enrolled in this study.

METHODS

Nursing students who volunteered to participate in the study completed self-reported scales on empathy, emotional intelligence, and moral sensitivity between September and October 2022. The potential mediating effect was explored using the Process Macro and bootstrap method.

RESULTS

The nursing students' average scores were 39.62 ± 5.27 on moral sensitivity, 108.21 ± 15.49 on empathy, and 124.41 ± 13.66 on EI. Moral sensitivity was positively correlated with emotional intelligence (r = 0.454, p < 0.001) and empathy (r = 0.545, p < 0.001). Furthermore, empathy exerted a substantial direct effect on nursing students' moral sensitivity (B = 0.1424, p < 0.001). Emotional intelligence could mediate the indirect path from empathy to moral sensitivity. (B = 0.0372, p < 0.001).

CONCLUSION

Emotional intelligence mediated the association between empathy and moral sensitivity. Thus, educational activities and programmes placing an emphasis on empathy and emotional intelligence may offer an alternative way to promote moral sensitivity in Chinese student nurses.

IMPLICATIONS

Nursing educators can organise programmes to improve nursing students' emotional competence and professional values. Early exposure to clinical practice benefits nursing students a lot in terms of building interactions with patients and increasing emotional resonance. In addition, nursing educators should develop situational teaching in nursing ethics courses to help students cope with ethical issues.

The relationship between teamwork, moral sensitivity, and missed nursing care in intensive care unit nurses

BACKGROUND

Teamwork, moral sensitivity, and missed nursing care are important healthcare challenges for Intensive Care Unit (ICU) nurses and the existence of a relationship between these variables can be useful for developing better care improvement strategies. This study aimed to determine the relationship between teamwork, moral sensitivity, and missed nursing care in ICU nurses.

METHODS

This is a descriptive cross-sectional study conducted on a total of 200 ICU nurses working at teaching hospitals affiliated to Semnan and Shahroud Universities of Medical Sciences, Semnan, Iran in 2022. Sampling was conducted using the census method. Data collection was conducted using a demographic checklist, the TeamSTEPPS Team Perception Questionnaire (T-TPQ), Lützén Moral Sensitivity Questionnaire (L-MSQ), and Kalisch and Williams Missed Nursing Care (MISSCARE) Survey. The examination of the relationship between the three variables was conducted using Pearson's correlation coefficient and multiple regression analysis.

RESULTS

The mean and standard deviation of teamwork, moral sensitivity, and missed nursing care was 3.47 ± 0.69, 64.19 ± 13.43, and 55.04 ± 34.10, respectively. The variable of teamwork had a significant positive relationship with moral sensitivity (p < .001) and a significant negative relationship with missed nursing care (p < .001). Teamwork was also a positive predictor of moral sensitivity (p < .001) and a negative predictor of missed nursing care (p < .001). The clinical experience of ICU nurses was a positive predictor of teamwork (p = .01) and a negative predictor of missed nursing care (p = .001). The age of ICU nurses was a positive predictor of moral sensitivity (p = .001) and a negative predictor of missed nursing care (p = .008).

CONCLUSION

The findings showed that a higher level of teamwork was associated with increased moral sensitivity and reduced missed nursing care among ICU nurses. Therefore, focusing on planning interventions on teamwork improvement can lead ICU nurses to improve moral sensitivity, lower missed nursing care, and promote the quality of patient care.

Critical Care Nurses' Adherence to Ethical Codes and Its Association with Spiritual Well-Being and Moral Sensitivity

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.