Beyond the Bedside: How Moral Sensitivity and Self-Efficacy Shape Person-Centered Care in Nursing

Background: Person-centered care (PCC) enhances the quality of care, safety, and satisfaction, yet many patients still do not consistently receive it. Evidence suggests that nurses' self-efficacy and moral sensitivity are necessary for implementing PCC, but both remain understudied, and many nurses show low levels of moral sensitivity. Few studies, particularly in Iran, have investigated these factors within multilevel contexts. This study examines this gap by exploring the relationship between moral sensitivity, self-efficacy, and PCC among hospital nurses in northern Iran. Methods: This cross-sectional study was conducted between 2022 and 2023 with 247 nurses from four public hospitals in northern Iran. Data were collected using validated Persian versions of the Person-Centered Care Assessment Tool, Moral Sensitivity Questionnaire, and General Self-Efficacy Scale. To account for the nested structure of the data (nurses within wards), a two-level hierarchical linear model was employed. This analysis assessed the associations of individual and ward-level collective moral sensitivity and self-efficacy with PCC, while adjusting for key demographic variables. Results: Two-level linear regression models were employed to examine the associations between moral sensitivity, general self-efficacy, and person-centered nursing, while adjusting for demographic variables and collective scores of moral sensitivity and general self-efficacy at the ward level. The analysis revealed that individual nurses' (Level 1) perceptions of moral sensitivity demonstrated a significant positive association with person-centered nursing (B = 0.271, p < 0.001). Also, the majority of participants had over 5 years of work experience (46.6%) and most of them had a monthly income between 6 and 12 million Tomans (51.1%). The intraclass correlations (ICC) were calculated for all four models. The empty model indicated that 13.21% of the variance in PCC was attributed to ward level factors. However, in model 4, following the inclusion of contextual variables at the ward level, the ICCs decreased to 4.84%. This reduction suggests that a portion of the variance was explained by the collective moral sensitivity and general self-efficacy variables at the ward level. Conclusion: The moderate level of PCC observed among nurses may indicate the need for implementing strategies to enhance their comprehension of this concept. Given the critical role of moral sensitivity in delivering PCC, it is advisable to prioritize the recruitment of nurses with robust ethical competencies. Additionally, providing in-service learning opportunities and organizational support is recommended to cultivate moral sensitivity and elevated care quality.