A Correlational Examination of Person-Centered Care, Critical Reflection, and the Nursing Work Environment: Evidence...

This study aimed to determine the extent to which critical reflection competency (CRC) and a healthy work environment (HWE) predict person-centered care (PCC) among nurses in Iranian teaching hospitals.

PCC is a fundamental model in healthcare, yet its implementation faces persistent challenges. Critical reflection and a supportive work environment are key factors that may influence care quality, but their simultaneous contribution to PCC dimensions remains underexplored.

This cross-sectional study was conducted across four Iranian teaching hospitals with a sample of 340 nurses. Data collection (March-June 2025) used three validated instruments: the person-centered practice inventory (PCPI), the critical reflection competency scale (CRCS), and the quality of healthy work environment (QHWE) instrument. Data were analyzed using descriptive statistics, Pearson's correlation, and hierarchical regression analysis.

CRC and HWE were significant positive predictors across all PCC dimensions. CRC was the strongest predictor for prerequisites (β = 0.506, p < 0.001) and care processes (β = 0.560, p < 0.001), whereas HWE was the strongest predictor for the care environment (β = 0.408, p < 0.001). The final models explained 36.7%-41.7% of the variance in PCC dimensions. The initial negative effect of higher patient-to-nurse ratios became nonsignificant after accounting for CRC and HWE, except for care processes where it remained significant (β = -0.011, p < 0.001).

These findings suggest that PCC is associated with the interplay of nurses' individual reflective competencies and the organizational context. Enhancing PCC may require simultaneous attention to fostering critical reflection and implementing organizational reforms that promote a healthier work environment, adequate staffing, and gender-sensitive practices.

PCC is predicted by both critical reflection and a HWE. Improving PCC likely depends on strengthening reflective abilities alongside organizational changes, rather than focusing solely on individual training.

This study highlights key strategies for nursing managers to implement PCC. Managers should integrate reflective practice into daily routines, adopt gender-sensitive leadership to improve fairness and support, advocate for safer staffing ratios, and include reflection competencies in training. Additionally, aligning managerial incentives with workplace culture improvements can help create sustainable environments for daily PCC practice.

This study examined nurses' perceptions exclusively; therefore, patients, service users, caregivers, and the public were not involved in the design, conduct, analysis, or manuscript preparation.