Care is the basis of the nursing profession and nurse’s caring behavior is one of the important factors in patient satisfaction. On the other hand, psychological empowerment can improve the provision of care services, and leaders have a significant impact on the behavior of followers. This study determined the correlation between ethical leadership, psychological empowerment, and caring behavior from nurses’ perspective.
Methods
This cross-sectional descriptive study was conducted in 2019. A total of 200 nurses were selected by stratified random sampling. Data were collected with ethical leadership, caring behavior and psychological empowerment questionnaires and analyzed with descriptive statistics (mean and standard deviation, frequency distribution) and inferential statistics (Pearson correlation coefficient, regression, and t-test) using SPSS20.
Results
The findings showed a significant correlation between ethical leadership, psychological empowerment (P < 0.001, r = 0.24) and caring behavior of nurses (P < 0.001, r = 0.25). Also, there was a significant correlation between psychological empowerment and nurses’ caring behavior (P = 0.002, r = 0.21). The regression analysis showed that ethical leadership and psychological empowerment are a predictor of caring behavior of nurses.
Conclusion
Applying an ethical leadership style by nursing managers can lead to nurses’ improved psychological empowerment and caring behaviors and ultimately, patient care quality. Thus, considering guidelines at the team and organizational levels and programs such as providing workshops and periodic counseling to cultivate ethical nurse leadership can lead to better caring behavior.
LabragueLJMcEnroe ‐PetitteDMPapathanasiouIV, et al.
Nursing students' perceptions of their own caring behaviors: a multicountry study. Int J Nurs Terminol Knowledge2017;
28: 225–232.
2.
American Association of the Critical Nurses’ Synergy Model for Patient Care. AACN Synergy Model for Patient Care.
Aliso Viejo, CA:
American Association of Critical-Care Nurses, 2017, pp.1–9, https://www.aacn.org/nursing-excellence/aacn-standards/synergy-model (Accessed January, 2020).
3.
AkanselNWatsonRVatanseverN, et al.
Nurses’ perceptions of caring activities in nursing. Nurs Open2021;
8: 506–516.
4.
SulimanWAWelmannEOmerT, et al.
Applying Watson's nursing theory to assess patient perceptions of being cared for in a multicultural environment. J Nurs Res2009;
17: 293–300.
5.
LeiningerM.Culture care theory: a major contribution to advance transcultural nursing knowledge and practices. J Transcult Nurs2002;
13: 189–192.
6.
MardianaSSWidyawatiI. The effectiveness of PSBH (problem solving for better health and hospital) method on caring nurse behavior. In: 1st Paris Van Java international seminar on health, economics, social science and humanities (PVJ-ISHESSH 2020)2021, pp.454–457. Dordrecht: Atlantis Press.
7.
AikenLHClarkeSPSloaneDM, et al.
Nurses’ reports on hospital care in five countries. Health Aff2001;
20: 43–53.
8.
SodeifyRVanakiZMohammadiE.Psychological empowerment in Iranian clinical nurses. Avicenna J Nurs Midwifery Care2012;
20: 46–56 (in Persian).
9.
SakGRothenfluhFSchulzPJ.Assessing the predictive power of psychological empowerment and health literacy for older patients’ participation in health care: a cross-sectional population-based study. BMC Geriatr2017;
17: 1–15.
10.
AziziSMHeidarzadiESoroushA, et al.
Investigation the correlation between psychological empowerment and assertiveness in nursing and midwifery students in Iran. Nurs Educ Pract2020;
42: 102667.
11.
HermanssonEMårtenssonL.Empowerment in the midwifery context – a concept analysis. Midwifery2011;
27: 811–816.
12.
DuffE.A structural equation model of empowerment factors affecting nurse practitioners competence. Nurs Educ Pract2019;
38: 145–152.
13.
KhoshmehrZBarkhordari-SharifabadMNasirianiK, et al.
Moral courage and psychological empowerment among nurses. BMC Nurs2020;
19: 1–7.
14.
KebriaeiARakhshaninejadMMohseniM.Influence of psychological empowerment on organizational commitment among medical employees in a hospital setting. Bangladesh Med Res Counc Bull2015;
40: 107–112.
15.
LoesCNTobinMB.Organizational trust, psychological empowerment, and organizational commitment among licensed practical nurses. Nurs Adm Q2020;
44: 179–187.
16.
OuyangY-QZhouW-BQuH.The impact of psychological empowerment and organisational commitment on Chinese nurses’ job satisfaction. Contemp Nurse2015;
50: 80–91.
17.
YaminAEBoulangerVMFalbKL, et al.
Costs of inaction on maternal mortality: qualitative evidence of the impacts of maternal deaths on living children in Tanzania. PloS One2013;
8: e71674.
18.
WangSLiuY.Impact of professional nursing practice environment and psychological empowerment on nurses' work engagement: test of structural equation modelling. J Nurs Manage2015;
23: 287–296.
19.
CaseyMSaundersJO'HaraT.Impact of critical social empowerment on psychological empowerment and job satisfaction in nursing and midwifery settings. J Nurs Manage2010;
18: 24–34.
20.
O'BrienJl.Relationships among structural empowerment, psychological empowerment, and burnout in registered staff nurses working in outpatient dialysis centers. Nephrol Nurs J2011;
38: 475--481.
21.
HanS-SMoonSJYunEK.Empowerment, job satisfaction, and organizational commitment: comparison of permanent and temporary nurses in Korea. Appl Nurs Res2009;
22: e15–e20.
22.
ElkholySMEl DahshanMEAAbd El MageedHH.Authentic leadership and its relation to structural empowerment and work environment among nurses. Am J Nurs2020;
9: 136–144.
23.
OgataYSasakiMYumotoY, et al.
Reliability and validity of the practice environment scale of the nursing work index for Japanese hospital nurses. Nurs Open2018;
5: 362–369.
24.
NorthousePG.Leadership: Theory and Practice.
Thousand Oaks, CA:
Sage publications, 2018.
25.
JambawoS.Transformational leadership and ethical leadership: their significance in the mental healthcare system. Br J Nurs2018;
27: 998–1001.
26.
García‐SierraRFernández‐CastroJ.Relationships between leadership, structural empowerment, and engagement in nurses. J Adv Nurs2018;
74: 2809–2819.
27.
BrownMETreviñoLKHarrisonDA.Ethical leadership: a social learning perspective for construct development and testing. Organ Behav Hum Decis Process2005;
97: 117–134.
28.
QiuSDooleyLMDengR, et al.
Does ethical leadership boost nurses’ patient‐oriented organizational citizenship behaviours? A cross‐sectional study. J Adv Nurs2020;
76: 1603–1613.
29.
Barkhordari-SharifabadMAshktorabTAtashzadeh-ShooridehF.Exploration of pioneering as a major element of ethical leadership in nursing: a qualitative study. Electron Phys2017;
9: 4737–4745.
30.
Barkhordari-SharifabadMAshktorabTAtashzadeh-ShooridehF.Ethical leadership outcomes in nursing: a qualitative study. Nurs Ethics2018;
25: 1051–1063.
31.
Barkhordari-SharifabadMAshktorabTAtashzadeh-ShooridehF.Ethical competency of nurse leaders: a qualitative study. Nurs Ethics2018;
25: 20–36.
32.
Barkhordari-SharifabadMMirjaliliN-S.Ethical leadership, nursing error and error reporting from the nurses’ perspective. Nurs Ethics2020;
27: 609–620.
33.
AloustaniSAtashzadeh-ShooridehFZagheri-TafreshiM, et al.
Association between ethical leadership, ethical climate and organizational citizenship behavior from nurses’ perspective: a descriptive correlational study. BMC Nurs2020;
19: 8.
34.
ZamanzadehVValizadehLPraskovaA, et al.
Reaching for the stars: Iranian nurses’ perceptions of career success. Int Nurs Rev2019;
66: 78–86.
35.
BoozaripourMAbbaszadehAShahriariM, et al.
Ethical values in nurse education perceived by students and educators. Nurs Ethics2018;
25: 253–263.
36.
ShahriariMMohammadiEAbbaszadehA, et al.
Perceived ethical values by Iranian nurses. Nurs Ethics2012;
19: 30–44.
37.
RafiiFHajinezhadMEHaghaniH.Nurse caring in Iran and its relationship with patient satisfaction. Aust J Adv Nurs2008;
26: 75–84.
38.
Bagheri KashkouliAZarabiAMousaviM.Prioritizing effective factors on the realization of creative city through sustainable development index assessment (case study: cities of Yazd province). J Geogr Reg Dev2020;
17: 51–23.
39.
FazelAKamalianARoshanSA.Relationship between ethical leadership and student’s empowerment. Ethics Sci Technol2017;
11: 59–68 (in Persian).
40.
MohammadimehrMHosseinpourE.The relationship between managers' ethical leadership style with professional commitment and ethical sensitivity among physicians of a military hospital. MCS2020;
6: 296–304 (in Persian).
41.
KahriziKSanganiPTAhmadAbadiA.The impact of managers' ethical leadership dimensions on teachers' organizational citizenship behavior. Teacher Prof Dev2019;
4: 43–59 (in Persian).
42.
GolestanipourM.Simple and multiple relationships between ethical leadership, transformational leadership and ethical climate and organizational spirituality among the employees of the Iran national steel industrial group. RES2016;
8: 183–189.
43.
SpreitzerGM.Psychological empowerment in the workplace: dimensions, measurement, and validation. Acad Manage J1995;
38: 1442–1465.
44.
ZahednezhadHManoochehriHZaghari TafreshiM, et al.
Relationship between organizational justice and nurses’ psychological empowerment. IJN2015;
28: 78–86 (in Persian).
45.
WolfZRGiardinoEROsbornePA, et al.
Dimensions of nurse caring. Image J Nurs Sch1994;
26: 107–112.
46.
WuYLarrabeeJHPutmanHP.Caring behaviors inventory: a reduction of the 42-item instrument. Nurs Res2006;
55: 18–25.
47.
AsadiSEShams NajafabadiR.Nurses' perception of caring behaviors in intensive care units in hospitals of Lorestan University of Medical Sciences. Iran. Med Surg Nurs J2014;
3: 170–175 (in Persian).
48.
JeonSHParkMChoiK, et al.
An ethical leadership program for nursing unit managers. Nurse Educ Today2018;
62: 30–35.
49.
ÖzdenDArslanGGErtuğrulB, et al.
The effect of nurses’ ethical leadership and ethical climate perceptions on job satisfaction. Nurs Ethics2019;
26: 1211–1225.
ZhangNLiMGongZ, et al.
Effects of ethical leadership on nurses’ service behaviors. Nurs Ethics2019;
26: 1861–1872.
52.
Ganji-ArjenakiMDalviM.The impact of ethical leadership on job stress and occupation turnover intention in nurses of hospitals affiliated to Shahrekord University of Medical Sciences. J Shahrekord Univ Med Sci2014;
16: 121–128 (in Persian).
53.
MoradiZIravanynejadSMoiniM.Nursing leadership styles and nurses’ job motivation in Shahid Chamran Hospital. J Educ Ethics Nurs2015;
4: 15–23 (in Persian).
54.
ShoridehFAAshktorabTYaghmaeiF.Iranian intensive care unit nurses’ moral distress: a content analysis. Nurs Ethics2012;
19: 464–478.
55.
BorhaniFAlhaniFMohammadiE, et al.
Professional ethical competence in nursing: the role of nursing instructors. J Med Ethics Hist Med2010;
3: 3–8.
56.
RoyanSAlikhaniMMohseniM, et al.
Nurses' psychological empowerment in Iran: a systematic review and meta-analysis. Ann Trop Med Public Health2017;
10: 1558–1562.
57.
MirkamliSNastiezaieN.The relationship between psychological empowerment and job satisfaction of nursing staff. J Urmia Nurs Midwifery Faculty2010;
8: 104–113 (in Persian).
58.
IbrahimMMEl-MagdMHASayedHY.Nurse's psychological empowerment and perceived autonomy in university and teaching hospitals at Menofia Governorate/Egypt. JNEP2014;
4: 59.
59.
Barkhordari-SharifabadMNadian-SadehHSedaghati-KasbakhiM.The relationship between spiritual intelligence with caring behavior and empathy in nurses working in hospitals affiliated to university of medical sciences of Kashan. J Nurs Educ2020;
8: 1–10 (in Persian).
60.
JoolaeeSRastiFGhiyasvandianS, et al.
Patients’ perceptions of caring behaviors in oncology settings. Iran J Nurs Res2014;
9: 59–67 (in Persian).
61.
LabragueLJDe los SantosJAATsarasK, et al.
The association of nurse caring behaviours on missed nursing care, adverse patient events and perceived quality of care: a cross‐sectional study. J Nurs Manage2020;
28: 2257–2259.
62.
SuprajitnoSKartikasariYAnggraeniENB.Relationship of nurse caring behaviour with patient satisfaction at the emergency department of Catholic Hospital of Budi Rahayu Blitar. J Nurs Midwifery2020;
7: 001–005.
63.
ChirashaVZangairaiSMutandwaP.Quality care nursing at Masvingo provincial hospital in Zimbabwe. Cogn Psychol2017;
2: 102–110.
64.
RastegarASaifMFarhadpourS.Moderating role of ethical climate and organizational loyalty in impact managers’ ethical behaviors on caring behaviors of nurses. Q J Nurs Manage2017;
5: 38–52 (in Persian).
65.
ZaghiniFFioriniJPireddaM, et al.
The relationship between nurse managers' leadership style and patients' perception of the quality of the care provided by nurses: cross sectional survey. Int J Nurs Stud2020;
101: 103446–103448.
66.
IslamTAhmedIAliG.Effects of ethical leadership on bullying and voice behavior among nurses. Leadersh Health Serv2019;
32: 2–17.
67.
VesterinenSSuhonenMIsolaA, et al.
Nurse managers’ leadership styles in Finland. Nurs Res Pract2012;
2012: 1–8.
68.
OducadoRM.Leader empowering behaviors and psychological empowerment as perceived by young hospital staff nurses: a pilot study. J Ners2019;
14: 47–54.
69.
SuifanTSDiabHAlhyariS, et al.
Does ethical leadership reduce turnover intention? The mediating effects of psychological empowerment and organizational identification. J Hum Behav Soc Environ2020;
30: 410–428.
70.
HuYZhuLZhouM, et al.
Exploring the influence of ethical leadership on voice behavior: how leader-member exchange, psychological safety and psychological empowerment influence employees’ willingness to speak out. Front Psychol2018;
9: 1--10.
71.
DustSBResickCJMawritzMB.Transformational leadership, psychological empowerment, and the moderating role of mechanistic–organic contexts. J Organ Behav2014;
35: 413–433.
72.
AslinnasabFDaneshamoozM.The effect of ethical leadership on psychological empowerment: the moderating role of organizational justice. Humanities2017;
4: 69–84.
73.
Moosavi JedMGhanbariSZandiK, et al.
The role of ethical leadership in nurses' psychological empowerment. Hospital2015;
13: 73–81 (in Persian).
74.
RandallDMFernandesMF.The social desirability response bias in ethics research. J Bus Ethics1991;
10: 805–817.
75.
LamSSHuiCLawKS.Organizational citizenship behavior: comparing perspectives of supervisors and subordinates across four international samples. J Appl Psychol1999;
84: 594–601.
