Factors predicting holistic nursing competence in a sample of nurses caring for older adults

The significant growth of the older adult population globally, including in Iran, has further underscored the need for comprehensive, effective, and competency-based nursing care. Holistic Nursing Competence (HNC) is a multidimensional concept. In the care of older adults, it is influenced by ethical, attitudinal, individual, and occupational factors.

The objective of this study was to identify the predictors of HNC among nurses providing care to older adults in Iran.

This was a descriptive study with a correlational design, conducted from 20 July 2024 to 15 January 2025 in the west of Mazandaran Province, Iran. A total of 784 clinical nurses were enrolled via convenience sampling. Data were collected using the Holistic Nursing Competence Scale (HNCS), the Ethical Attitude Scale in Nursing Care (EASNC), the Ethical Care Competence Scale (ECCS), an ageism questionnaire, and a demographic and occupational information questionnaire. Data were analyzed using descriptive statistics and multiple linear regression with SPSS software version 26.

The mean HNC score (96.96 ± 30.28) was in the upper range of the moderate category, indicating a moderately high level. The results of multiple regression analysis (stepwise method) indicated that ethical care competence (β = 0.62, large effect, p < 0.001), ethical attitude for nursing care (β = 0.11, medium effect, p < 0.001), history of in-service training in holistic nursing empowerment (β = 0.07, small effect, p = 0.002), and ageist attitudes (β = 0.07, small effect, p = 0.014) were significant predictors of HNC. These four variables collectively explained 56% of the variance in HNC scores (Adjusted [Formula: see text]=0.56). Among these, ethical care competence was identified as the strongest predictor of HNC in the care of older adults. Furthermore, correlation analyses revealed that contextual variables such as age, work experience, job satisfaction, employment type, and place of work were also significantly correlated with HNC, underscoring the importance of considering individual, professional, and organizational dimensions in promoting holistic care.

The findings of this study indicate that HNC in the care of older adults is influenced by ethical competencies, attitudes towards aging, professional training, and work-related environmental factors. Therefore, developing structured in-service training programs, promoting ethical conduct in nursing, and reducing ageist attitudes are considered effective strategies for enhancing HNC. The results of this research can inform policies in nursing education and human resource development.