Nurses are the largest group of health care providers and have a significant impact on the quality of health care [1]. Caring is an important concept and, in fact, it is an art [2]. In this context, it can be said that nursing profession has moral codes that having knowledge about them does not guarantee their practice and nursing students should be sensitive enough to implement these codes [5]. Moral Sensitivity, Awareness, and Attention to Contradictory Moral Values ​​in a situation and Self-Awareness of a Man's Role and Duty in that special situation are what lead to morality [6]. Because nurses have the most human contact with patients in terms of time and depth, the importance of their moral care sometimes outweighs the technical aspects of nursing [10, 9]; therefore, moral awareness is of particular importance in the health community. Developing moral sensitivity creates a basic reaction and attitude for nurses so that they can take effective and moral care of their patients with appropriate ethical decisions [11]. Some studies have shown that nurses are weak in applying ethical principles to their decisions. And do not have sufficient moral sensitivity [15,14]. Lee and Kim also found that nursing students' moral sensitivity was unacceptable and needed to be improved. They also concluded that moral sensitivity was directly related to patient safety. The higher the moral sensitivity, the greater the safety of patients [22]. Also, in order for nursing students to perform at a high level and be able to identify and express the different needs of patients, they must first be aware of their health needs, especially spiritual health. [23] Chiang et al. believe that the spiritual health of nurses is one of the most important value and belief systems that can have a great impact on their attitude and performance in caring for patients and their professional commitment [24]. In nursing education, nursing students become acquainted with moral decision-making models and, after graduation, encounter tensions between what they have learned and what is available in the workplace; therefore, they must show clinical competence and moral sensitivity facing these tensions. Therefore, it is necessary to examine how they deal with moral issues and the extent of their moral sensitivity in the field of nursing work and determine the factors affecting it. The present study was conducted to determine the relationship between spiritual health and moral sensitivity in nursing students.

 

The present study is a descriptive-cross-sectional study of the type of correlation. Third and fourth year undergraduate nursing students (due to more attendance at bedtime) and postgraduate nursing students at Hamadan School of Nursing and Midwifery in the first semester of the academic year were 2017-2018 were considered to be the research community (123 people). Sample students were selected from the students who had the criteria to enter the study and wanted to participate in the study, as a sample of the census. In order to collect data, a three-part questionnaire including demographic questionnaire, standard questionnaire of nurses' moral sensitivity in decision making and spiritual health questionnaire was completed by the sample individuals.
The Demographic Questionnaire consists of 5 questions related to individual characteristics (including age, sex, marital status, level of education and history of participation in the ethics workshop). The standard questionnaire for nurses' ethical sensitivity in decision making was developed by Nordin, Lützén and Brolin in Sweden [25]. Then, this questionnaire was used in different countries, including Iran. The validity of this questionnaire in Iran was assessed by Hassanpoor et al., whose reliability was 0.81 [15]. Pearson correlation coefficients were analyzed. It is worth mentioning that the level of significance in this study was considered to be 0.05.

The mean age of participants was 23.69±4.55 years. Most nursing students had moderate spiritual health score and moral sensitivity. There was a positive and significant correlation between spiritual well-being with nursing students 'moral sensitivity (r=0.26, P=0.003), meaning that the higher the students' spiritual health score, the higher their moral sensitivity.

In the present study, the relationship between spiritual health and moral sensitivity of nursing students was examined. In general, the findings showed that there was a positive and significant relationship between spiritual health and moral sensitivity of nursing students, so that with increasing mental health, the moral sensitivity of nursing students increases. According to a study, nursing students in Qom have moderate spiritual health, and the next score on religious health is higher than the existential health, which is consistent with the findings of the present study [27]. The results of Rahimi, Nouhi and Nakhaee study also showed that nursing and midwifery students in Kerman also have moderate spiritual health, which is consistent with the findings of the present study [20]. In research, the average and relatively optimal level of spiritual health of the study population has been attributed to the religiosity of the Iranian society and the tendency of individuals to observe spiritual values, in other words, the culture of the country [28]; therefore, such results are not unexpected for our society, which is inclined to religious and spiritual values, but due to the importance of spiritual health, the need to promotion of the spiritual health of nursing students is felt.
In this study, nursing students had moderate moral sensitivity. The level of moral sensitivity of nursing students at Bushehr University of Medical Sciences was also moderate, which is consistent with the present study [29].
In this study, a positive and significant relationship was observed between the spiritual health and moral sensitivity of nursing students. In this way, with the increase in the level of spiritual health, the moral sensitivity of nursing students increases. It should be noted that no study found that the relationship between the two variables was measured in the nursing group, but in studies close to the subject, it can be noted that in nursing students, spiritual health is positively associated with anxiety [30], happiness [31] and the psychological potential of nursing students [32] which can play a significant role in increasing the moral sensitivity of nursing students.

 

Given the role of spiritual health in the moral sensitivity of nursing students, it is recommended to strengthen this dimension of people's health, so that management decisions can be effective for nursing students in order to improve mental health conditions and increase moral sensitivity in universities.

 

The present study is the result of a research project No. 9611247564 approved by Hamadan University of Medical Sciences with the code of ethics IR.UMSHA.REC.1397.19. Hereby, the Vice Chancellor for Research of Hamadan University of Medical Sciences and the participants are sincerely thanked and appreciated for their cooperation in conducting this study.

 

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.