The mediating role of empathy in relationships between conscientious intelligence and perceptions of spiritual care among Turkish nurses; A structural equation modelling

The mediating role of empathy in relationships between conscientious intelligence and perceptions of spiritual care among Turkish nurses; A structural equation modelling | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The mediating role of empathy in relationships between conscientious intelligence and perceptions of spiritual care among Turkish nurses; A structural equation modelling Seçil ERGİN DOĞAN, Hakime Aslan, Abdurrahman Akçin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5895594/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Jul, 2025 Read the published version in BMC Nursing → Version 1 posted 10 You are reading this latest preprint version Abstract Aim This research aimed to determine the relationship between nurses' conscientious intelligence levels, empathy levels and perceptions of spiritual care. Material and Methods This research is cross-sectional type. This study was conducted with 315 nurses working in a training and research hospital in the east of Turkey. ‘Conscientious Intelligence Scale’, ‘Empathy Quotient Scale’ and ‘Spirituality and Spiritual Care Rating Scale’ are data collection tools. The descriptive analyses of the data obtained were analyzed with Statistical Package for Social Sciences 25.0 program and Analysis of Moment Structures 26.0 program. Results As a result of structural equation modelling, nurses’ conscientious intelligence levels had a positive and significant effect on their empathy levels (β 1 : 0.169, p = 0.005), nurses’ empathy levels had a positive and significant effect on their perceptions of spirituality and spiritual care (β 1 : 0.304, p < 0.001) and nurses' conscientious intelligence levels had a positive and significant effect on their perceptions of spirituality and spiritual care (β 1 :0.311, p < 0.001). In addition, empathy mediated the relationship between conscientious intelligence and perception of spirituality and spiritual care (Two Tailed Significance value is 0.02 and below the 95% confidence interval). Conclusion As a result, it was determined that there was a significant relationship between nurses' levels of conscientious intelligence and their perceptions of empathy and spiritual care, and empathy mediated the relationship between conscientious intelligence and perception of spiritual care. In this context, it is thought that the development of empathy skills can play an important role in strengthening nurse-patient relationships and increasing patient satisfaction and can lead to concrete improvements in professional practices by integrating into nursing practices. For this, it is recommended that empathy-based intervention strategies should be integrated into nursing education curricula. Empathy Conscientious intelligence Spirituality Spiritual Care Nurses Türkiye Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Nursing is a profession based on human needs and the only task that has not changed throughout history is care, which is the basis of nursing practices [ 1 ]. While providing care, nurses have to make the right decision in order not to harm human health and dignity. Nurses' conscience is a prerequisite for them to make the most ethically correct decision and provide care [ 2 ]. Conscience is a feeling that leads a person to be in favor of doing good, to reject evil and to be uneasy with evil, and is an emotion that constantly judges. It is also the ability to morally judge one's conscious actions and the level of understanding of what is right or wrong [ 3 ]. For nurses to provide effective care and protect their own health, intelligence, which is the ability to solve problems, is important as well as the ability of conscience to make the right decision [ 2 ]. Intelligence is all human abilities of thinking, reasoning, perceiving objective facts, judging and drawing conclusions, comprehension, intelligence and heredity [ 4 , 5 ]. In the information age, a different dimension was brought to the concept of intelligence, and the concept of 'conscientious intelligence' emerged by using conscience and intelligence together [ 3 , 6 ]. Conscientious intelligence, also known as spiritual intelligence, is listening to one's inner voice and being aware of one's internal and external responsibilities [ 7 ]. Listening to the inner voice, being aware of internal and external responsibilities, responsibility towards the creator, accountability, having ethical values, reasoning, being humble, having principles, wisdom and honesty constitute the values of conscientious intelligence [ 7 ]. Tarhan (2012) defines conscientious intelligence as the ability to act in awareness of one's responsibilities and at an internal level of consciousness [ 7 ]. Conscientious intelligence forms a whole with dimensions such as inner voice listening, corresponding to internal and external responsibility, accountability, and acting according to moral values, which include one's responsibility towards oneself and others [ 3 , 7 ]. Conscientious intelligence is based on conscientious values [ 7 ]. It is anticipated that in organizations where individuals act according to conscientious values, activities will be conducted for the benefit of all stakeholders [ 8 ]. It is inevitable that nurses, who constitute an important component of health care systems, acting according to conscientious values will provide significant benefits to the health system [ 9 , 10 ]. Conscientious values help nurses to provide quality and honourable care, to be understanding and careful in care delivery, reduce errors, encourage the protection of patient rights, and play an important role in decision-making, informing and guiding professional practices [ 1 , 11 ]. In studies conducted in Turkey, it has been determined that conscientious intelligence is also effective in increasing nurses' work motivation and managing patient expectations [ 2 , 4 ]. For these reasons, conscientious intelligence, which originates from conscientious values, has a very important place in nurses [ 12 ]. It has been stated that the high level of conscientious intelligence of nurses will enable them to solve their problems conscientiously, improve themselves by adopting a conscientious approach, and achieve prosperity and happiness [ 13 ]. In addition to nurses' own happiness, it has also been determined that the development of conscientious intelligence can help nurses to improve their creativity, productivity, versatility and communication skills for the benefit of patients [ 14 ]. In addition to the conscientious intelligence of nurses, their level of empathy is also very important in fully meeting patient needs, increasing satisfaction and maintaining healthy communication. Patients from different cultures have different health conditions such as nutrition, pain, tendency to alternative treatment methods, health-disease perceptions, and body language use. Conscience enables us to understand and respect these differences and the different values of patients [ 4 ]. The nurse should demonstrate an empathic approach to detect differences. Empathy in nursing is defined as the ability to fully understand and share the patient's feelings and thoughts by establishing healthy communication with evidence-based constructive approaches. Shared understanding based on empathic communication complements useful data for planning individualized care that encourages patients to actively regulate their health [ 15 ]. Empathy, caring, compassion and personal characteristics of the nurse are indicators of a value that is fundamental to the professional identity and ideology of nursing [ 16 ]. In order for the nurse to assist the patient they are caring for, it is essential for them to first reach out to the patient, show respect, try to understand them, engage with them, be aware of their needs, and maintain a relationship based on trust. A nurse can only reach the patient through communication knowledge and skills. At this point, while the nurse forms the foundation of care with an empathetic understanding, they also take the patient's culture into account when addressing individual needs effectively. The nurse reflects the importance of cultural values, beliefs, practices, and attitudes in the foundation of care and demonstrates a holistic and humanistic approach to care by using the ability to empathize [ 17 , 18 ]. Holistic nursing care is a special nursing practice that argues that body, mind, spirit, emotions, environment, relationships and social and cultural aspects of life are interconnected and should be handled as a whole [ 19 ]. Holistic nurses should be able to use their intuition in addition to knowledge, theory, expertise and experience in order to provide care to the patient as a whole in the healing process of the patient [ 20 ]. In addition, they should maintain holistic communication, respect cultural diversity and show an empathic approach by accepting differences. Thus, a real holistic nursing care can be mentioned [ 21 ]. When we look at the definitions of the concepts of conscience and empathy, which emphasize the spiritual aspect of human beings, it is seen that they are intertwined concepts [ 22 ]. In addition, a nurse's ability to exhibit empathic behaviors depends on her/his spirituality [ 23 ]. According to the holistic approach, the individual is a whole with physical, emotional, mental, social, cultural and spiritual aspects. To protect and maintain the integrity of a person, spiritual needs must be met in addition to all their needs [ 24 ]. Spirituality is the life force in the individual, the search for the meaning and purpose of life, being in a relationship with the creator, healing through prayer, faith and meditation, and a sense of well-being through inner peace [ 25 ]. Spirituality can be defined as a broader and more universal construct than religiosity; spirituality is framed as a subjective experience that can exist both inside and outside a religious framework [ 24 ]. Spirituality plays a holistic and unifying role in medical and social services and plays an important role in helping people to regain their health, or if this is not possible, to face the current situation and maintain their connections with life [ 24 ]. Ethical and effective nursing care should respect the patient's spirituality and religiosity. Given this imperative, nurses are increasingly expected to provide spiritual care that assesses and addresses the spiritual distress and challenges of patients and families [ 26 ]. Spirituality-oriented nursing care includes diagnosing the spiritual needs of the individual, planning interventions for these needs, implementing interventions, as well as supporting the individual and evaluating the care [ 25 ]. Active listening and empathic approach, recognizing the spiritual, physical and emotional needs of the patient, supporting the patient's beliefs, the meaning attributed to the disease, spiritual history and religious practices are the practices that constitute spiritual nursing care [ 27 ]. However, nurses face some obstacles in providing spiritual care, such as insufficient time, lack of training, and the belief that spirituality is a private subject and that nurses should not enter this subject. Due to these obstacles, the frequency of nurses providing spiritual care decreases [ 24 ]. Conscientious intelligence has emerged as a result of the integration of intelligence with spirituality. The spiritual nature of man constitutes a motivation, the direction of which depends on human knowledge and reason. While recognising the similarity and integration between religion and spirituality, there is also a consensus on the differences and distinctions between them; religion focuses on the sacred, while spirituality points to meaning, sublimity and perfection [ 28 ]. In general terms, it is a known reality that the common goal of all religions is to bring peace and happiness to humanity on an individual and social basis and that they preach many universal human values and principles to achieve this goal. In this context, it is possible to state that the components of conscientious intelligence such as empathy, moral judgement, sense of justice, responsibility, respect, honesty and benevolence are also recognised and attributed importance as universal human values in religions. In this respect, it is possible to say that there are common denominators between spirituality and conscientious intelligence [ 29 ]. In the literature, it has been observed that some studies have been conducted on how to establish a relationship between conscientious intelligence and spirituality. For example, in the research conducted by Karakaş, it was determined that there was a positive relationship between spiritual intelligence and religiosity and flexibility of forgiveness [ 30 ]. Asıcı also found a positive relationship between emotional intelligence and forgiveness [ 31 ]. Özcan et al., also determined that there was a positive relationship between nurses' conscientious intelligence levels and care behaviours [ 1 ]. In these studies, it is seen that there are significant relationships between religion and spirituality and relationship intelligences and conscientious values. Based on this context, it was inevitable to address the relationship between nurses' conscientious intelligence and their perceptions of spiritual care. In the literature, it has been observed that there is a significant relationship between conscientious intelligence and empathy level, and there is a strong link between conscientious intelligence and spirituality in the context of values. However, in the literature search, it was observed that the studies evaluating the effect of nurses' conscientious intelligence levels on patient care outcomes were very limited. It is essential to investigate the positive results of conscience, which has an important place in nursing care, and to integrate it into nursing education. Based on this scope, this study was conducted to evaluate the relationship between nurses' conscientious intelligence levels and their perceptions of empathy and spiritual care. The hypotheses for the research were formed as follows; H 1 : There is a relationship between nurses' conscientious intelligence levels and empathy levels. H 2 : There is a relationship between nurses' empathy levels and their perceptions of spirituality and spiritual care. H 3 : There is a relationship between nurses' levels of conscientious intelligence and their perceptions of spirituality and spiritual care. H 4 : Empathy level mediates the relationship between nurses' levels of conscientious intelligence and their perceptions of spirituality and spiritual care. The research model and hypothesis were formed as follows; MATERIAL AND METHODS Study design The research is cross-sectional type. Participants and sampling This study was conducted between January and April 2024. The population of the study consisted of nurses working in a training and research hospital located in the Eastern Anatolia Region of Turkey. All nurses working in the relevant hospital constituted the population of the study (N: 1040). The sample consisted of 314 nurses determined by using G Power 3.1.9.7 programme (0.20 effect size and 0.05 margin of error and 95% confidence interval). Nurses were selected from the population using simple random sampling method. The nurses were informed about the study and asked to fill out the data collection forms completely. A total of 315 nurses who volunteered to participate in the study and completed the data collection forms completely were included in the study. Inclusion- Exclusion criteria All nurses who had been working as a nurse for at least 3 months and who agreed to participate in the study were included in the study. Nurses working in the operating theatre were not included in the study due to the protection of sterile environment and lack of patient communication. The nurses working in the operating theatre were excluded from the sample because the patient-nurse relationship is very limited and the interaction with patients is very limited compared to nurses working in other units. As a result, including them in the sample could have diluted the study's focus on the patient-nurserelationship and patient outcomes. However, excluding operating theatre nurses may also impact the generalizability of the study's findings. By not including a broader range of nursing roles that interact with patients in different contexts, the sample may not fully represent the diversity of nursing experiences across healthcare settings. This exclusion limits the ability to apply the study’s results universally to all nursing contexts, particularly in areas where nurses play a pivotal role in patient care throughout the entire treatment process, including during surgery. The impact on generalizability also extends to the potential differences in how patient care is delivered in the operating room versus other settings. Operating theatre nurses have unique skills and responsibilities that could influence patient outcomes in ways that are not captured by the study. Therefore, while the study design benefits from a more focused sample, the exclusion of operating theatre nurses reduces the representativeness of the findings in a broader nursing context. Data Collection and Instruments Procedure The researcher started the data collection process after obtaining institutional permission from the relevant hospital. To collect data, the researcher went to the hospital, provided the necessary explanations about the research, and obtained informed consent from the nurses. The researcher left as many survey forms as there were nurses working in the ward and then moved on to other clinics. The completed data collection forms were collected again in the evening. At the beginning of working hours, data collection forms were distributed to the nurses and collected at the end of working hours. The 'Personal Information Form,' consisting of questions related to age, gender, years of work experience, etc., which were determined based on the literature to identify the socio-demographic characteristics of nurses, as well as the The Conscientious Intelligence Scale (CIS)' Empathy Quotient Scale (EQS),' and Spirituality and Spiritual Care Rating Scale (SSCRS)' were used to collect data Personal Information Form It is a data collection tool consisting of eight questions (age, gender, educational status, years of employment, marital status, having children, satisfaction with the nursing profession) developed by the researchers. The Conscientious Intelligence Scale (CIS) It was developed by Aktı et al., (2017) to determine the level of conscientious intelligence of nurses. In the 5-point Likert-type scale, conscientious intelligence consists of a 7-factor structure including “ethical values”, “moral sensitivity”, “responsibility towards the creator”, “compassion”, “conscious awareness”, “social sensitivity” and “wisdom”. CIS consists of 32 items. These items are scored as “strongly disagree” (1 point), “disagree” (2 points), “undecided” (3 points), “agree” (4 points), “strongly agree” (5 points). The lowest score that can be obtained from this scale is 32, while the highest score is 160. Questions 1, 2, 3, 4 and 5 are reverse coded. In the development study of the scale, Cronbach's alpha coefficient for the total score of the CIS was determined as 0.85 [ 3 ]. In this study Chronbach’s alpha value was 0.85. Empathy Quotient Scale (EQS) It is a measurement tool that was adapted into Turkish by Barış and Çolakoğlu (2015) and validity and reliability study was conducted to determine the empathy level of nurses. The EQS consists of 13 items and 3 sub-dimensions. The sub-dimensions are categorized as Cognitive Empathy, Emotional Reaction and Social Skills. The scale has a 5-point Likert-type rating as “1” Strongly Disagree, “2” Disagree, “3” Undecided, “4” Agree and “5” Strongly Agree. Cronbach's alpha coefficient of EQS was determined as 0.78 [ 32 ]. In this study Chronbach’s alpha value was 0.76. Spirituality and Spiritual Care Rating Scale (SSCRS) In order to determine nurses' perception of spirituality and spiritual care, Ergül and Bayık Temel [2007] adapted the scale into Turkish and conducted a validity and reliability study. The scale includes a total of 17 questions and consists of “spirituality and spiritual care” (item 6,7,8,9,11,12,14), “religiosity” (item 4,5,13,16) and “individual care” (item 1,2,10,15) sub-dimensions. The items are scored from 1, which means “strongly disagree”, to 5, which means “strongly agree”. The first 13 items are scored straight and the last four items are scored in reverse. As the average total score increases, the level of perception of the concepts of spirituality and spiritual care increases positively. Accordingly, the highest score that can be obtained from the spirituality and spiritual care sub-dimension is 31, and 16 from the religiosity and individual care sub-dimensions. The highest score that can be obtained from the total scale is 69. Cronbach's alpha coefficient for the total score of the SSCRS was determined as 0.76 [ 33 ]. In this study Chronbach’s alpha value was 0.73. Data Analysis The data obtained were coded and entered into the IBM SPSS.25 (IBM Corp., Armonk, New York, USA) package program. Descriptive statistics (frequency and percentage) were made and it was analyzed whether the scale mean scores fit the normal distribution. As a result of the Kolmogorov Smirnov test, it was determined that the data fit the normal distribution and there was no missing data. Since the normal distribution was found, a model for the hypotheses was created in the IBM SPSS AMOS version 26 program and these hypotheses were tested. Ethical Consideration Research permission was obtained from the non-interventional ethics committee of Turgut Ozal University and then institutional permission was obtained from the training and research hospital where the research would be conducted (Decision number: 2024/01). The purpose of the study and ethical issues were informed to the nurses through the data collection form and their verbal and written permissions were obtained before the form was filled. Verbal/written informed consent was obtained from all of the participants in the study. They were informed that they could withdraw from the study at any time. Name and surname were not requested in the data collection form and it was stated that the data obtained would not be shared with third parties. RESULTS The sociodemographic data of the participants in the study are given in Table 1 . As seen in Table 1 , the majority of the nurses who participated in the study were female nurses. In addition, the highest number of participants were between the ages of 18–24, bachelor's degree, 1–5 years in the profession, married and satisfied with their profession (Table 1 ). Table 1 Sociodemographic Data of the Participants (N = 315) Socio-demographic variables n % Gender Female 280 88,9 Male 35 11,1 Age 18–24 93 29,5 25–30 88 27,9 31–35 31 9,8 36–40 20 6,3 41–45 55 17,5 46 and above 28 8,9 Education Level High School 15 4,8 Associate Degree 27 8,6 Bachelor’s Degree 257 81,6 Master's Degree 14 4,4 PhD 2 0,6 Years in the Profession 1–5 155 49,2 6–10 34 10,8 11–15 34 10,8 16–20 30 9,5 21 and above 62 19,7 Marital Status Married 167 53 Single 148 47 Satisfaction with Nursing Profession Yes 209 66,3 No 106 33,7 Investigation of the Measurement Model At this stage of the study, in order to establish the SEM in a healthier way, firstly, a restricted factor analysis, also known as confirmatory factor analysis (CFA), was applied to determine the scale validity for each dimension (EQS, CIS and SSCRS) in the study. In short, linear factor analysis is a SEM that examines the relationships between latent variables and indicators. The purpose of linear factor analysis is to estimate indicator error variances, factor loadings, factor covariances and variances, indicator error variances and covariances, in short, the variance covariance matrix that is most similar to the sample variance covariance matrix for each parameter in the measurement model [ 1 ]. According to the results of the linear factor analysis applied for each dimension, most of the goodness-of-fit indices were within the acceptance limits and the highly erroneous items that negatively affected the fit between the data and the model, the causal relationships between the data or the normal distribution of the data were removed from the model and covariances between some variables were created. The goodness of fit values after the modification improvements are presented in Table 2 (Table 2 ). Table 2 Model Measurement Values for Each Dimension Model Fit Measures EQS CIS SSCRS χ2/df 2.939 2.472 2.749 CFI 0.904 0.924 0.902 GFI 0.926 0.901 0.938 RMR 0.047 0.052 0.047 RMSEA 0.079 0.068 0.075 SRMR 0.0594 0.0578 0.0570 χ2: Chi-Square Value, df: Degrees of Freedom Value, CFI: Comperative Fix Index, GFI: Goodness of Fix Index, RMR: Root Mean Square Resiual, RMSEA: Root Mean Square Error of Approximation, SRMR: Standardized Root Mean Square Residual. There are certain value ranges for the indices used in the evaluation of model fit. The χ2/df ratio between 0.1 and 3 is considered appropriate and this ratio is within the specified value ranges for each dimension used in the study [ 35 , 36 ]. CFI and GFI indices between 0.80 and 0.90 are generally accepted and values above 0.90 indicate good fit [ 36 , 37 ]. For each dimension, a ratio above 0.90 indicates good fit. Another index, the RMR index, should be between 0–1 and a value less than 0.05 indicates good fit [ 38 ]. For each dimension, this value is within the specified value ranges. The RMSEA index between 0.05–0.08 indicates good fit and these values for each dimension are within the specified value ranges [ 35 , 39 , 40 ]. Finally, the SRMR index should be less than or equal to 0.08. For each dimension, this value being below 0.08 indicates good fit [ 41 ]. After it was determined that the measurement models fit the data as a result of the linear factor analysis performed separately for each dimension, linear factor analysis was applied to the first model in Fig. 1 for the mediator variable analysis to be investigated in hypothesis H 4 with structural equation modeling and to the second model in Fig. 2 , which includes all dimensions together to investigate hypotheses H 1 , H 2 and H 3 . The goodness of fit values of the research models are presented in Table 3 . Table 3 Measurement Values of the Research Model Model Fit Measures First Model Fit Values Second Model Fit Values χ2/df 1.984 2.104 CFI 0.878 0.814 GFI 0.841 0.785 RMR 0.070 0.069 RMSEA 0.056 0.059 SRMR 0.0770 0.0812 χ2: Chi-Square Value, df: Degrees of Freedom Value, CFI: Comperative Fix Index, GFI: Goodness of Fix Index, RMR: Root Mean Square Resiual, RMSEA: Root Mean Square Error of Approximation, SRMR: Standardized Root Mean Square Residual. When the first model fit indices were examined, χ2/df , CFI , GFI , RMR were within the acceptance limits and good model fit was determined for RMSEA and SRMR . When the second model fit indices were examined, χ2/df , CFI , RMR were within the acceptance limits and good model fit was determined for RMSEA and SRMR . Investigation of Structural Equation Model Structural equation modeling (SEM), which is based on the identification of observable and unobservable (latent) variables with causal relationships, represents the investigated causal relationships with structural equations, i.e. regressions. These structural relationships are modeled in a comprehensive and systematic way and presented to the researcher visually [ 39 ]. The mediating variable analysis is tested with the three-stage regression analysis proposed by Baron and Kenny (1986) [ 42 ]. These are respectively, for this research, the level of conscientious intelligence, which is the independent variable, has a significant effect on the perception of spirituality and spiritual care, which is the dependent variable; the level of empathy, which is the mediating variable, has a significant effect on the perception of spirituality and spiritual care; and when the level of empathy is included in the regression analysis in the second stage, the effect of conscientious intelligence on the perception of spirituality and spiritual care decreases, while the level of empathy has a significant effect on the perception of spirituality and spiritual care. SEM provides a more appropriate inference framework for mediation analyses and other types of causal analysis [ 43 ]. For these reasons, in this study, the mediating variable analysis investigating hypothesis H 4 was tried to be determined by SEM. Two separate models were established to investigate the stated effects. The first structural equation model in Fig. 2 investigates whether CIS, the independent variable, has a significant effect on SSCRS, the dependent variable, and the second structural equation model in Fig. 2 investigates whether there is a significant relationship between CIS and EQS; between EQS and SSCRS; and between CIS and SSCRS. Table 4 shows the hypothesis test results of structural equation modeling. In the first model, SSCRS was selected as the dependent variable and CIS was selected as the independent variable. The path coefficient between SSCRS and CIS was found to be significant ( \(\:{\beta\:}_{1}\) :0.361, p < 0.001), and nurses' conscientious intelligence levels had a positive and significant effect on their perceptions of spirituality and spiritual care (Table 4 , Fig. 2 ). Table 4 Regression Weight Values for the First and Second Models Tested Path \(\:{\varvec{\beta\:}}_{1}\) \(\:{\varvec{\beta\:}}_{2}\) S.E. (Standard Error) C.R. (Critical Rate) P (Sig.) SSCRS <--- CIS 0,361 0,684 0,106 6,443 *** Tested Path \(\:{\varvec{\beta\:}}_{1}\) \(\:{\varvec{\beta\:}}_{2}\) S.E. (Standard Error) C.R. (Critical Rate) P (Sig.) EQS <--- CIS 0,169 0,472 0,168 2,8 0,005 SSCRS <--- CIS 0,311 0,582 0,103 5,67 *** SSCRS <--- EQS 0,304 0,203 0,038 5,346 *** \(\:{\varvec{\beta\:}}_{1}\) : Standardized estimates, \(\:{\varvec{\beta\:}}_{2}:\) Unstandardized estimates, SE.:Standard Error, CR.: Critical Rate, p: Signifigence, *** p < 0,001 According to the test results of the 2nd and 3rd stages of the mediating variable analysis, the path coefficient between CIS and EQS representing hypothesis H 1 was found to be significant ( \(\:{\beta\:}_{1}\) :0.169, p = 0.005), and it was determined that nurses' conscientious intelligence levels had a positive and significant effect on their empathy levels. The path coefficient between EQS and SSCRS representing hypothesis H 2 was found significant ( \(\:{\beta\:}_{1}\) :0.304, p < 0.001), and it was concluded that nurses' empathy levels have a positive and significant effect on their perceptions of spirituality and spiritual care. Finally, the path coefficient between CIS and SSCRS representing hypothesis H 3 was found to be significant ( \(\:{\beta\:}_{1}\) :0.311, p < 0.001), and it was seen that nurses' conscientious intelligence levels had a positive and significant effect on their perceptions of spirituality and spiritual care. All this information indicates that EQS may be a mediating variable (Fig. 3 , Table 4 ). Finally, the results of the analysis that allows us to test the mediating effect of CIS on SSCRS through EQS are shown in the standardized indirect effects results table in Table 5 . Since the Two Tailed Significance value is 0.02 and below the 95% confidence interval, the mediation effect can be mentioned. In other words, EQS mediates the relationship between CIS and SSCRS, which represents hypothesis H 4 , and it is significant. In addition, the decrease in the coefficient of CIS in model 2, \(\:{\beta\:}_{1}\) (0.311), compared to the coefficient of CIS in model 1, \(\:{\beta\:}_{1}\) (0.361), means that CIS affects SSCRS through EQS. It is also seen that the coefficient of this mediating effect is in the range of Lower Bounds value 0.017 and Upper Bounds value 0.092 (Table 5 ). Table 5 Standardized Indirect Effects Results Standardized Indirect Effects Boyutlar CIS EQS SSCRS Lower Bounds SSCRS 0,017 0 0 Upper Bounds SSCRS 0,092 0 0 Two Tailed Significance SSCRS 0,02 - - DISCUSSION In this study, the relationship between conscientious intelligence levels, empathy and spiritual care perceptions of 315 nurses was investigated. In this study, we determined that the conscientious intelligence levels of nurses had a positive and significant effect on their empathy levels. People try to search for the meaning and significance of their behaviour and the questions they cannot answer. In fact, this search is a situation that people can learn through their own skills and even through the ways they will remember by evaluating them in the form of conscientiousness and empathy [22]. In addition to seeking answers to the questions they are looking for with their conscience and using empathy, people have also tried to come to a conclusion with the criticism of others by evaluating whether it is appropriate in terms of moral values [44]. Nurses who aim to provide holistic care to patients are expected to have developed levels of conscientious intelligence and high levels of empathy in order to respond to the problems and needs of patients. In the literature, there is no research on the relationship between conscientious intelligence and empathy level in nurses. However, in a study conducted on athlete students, it was found that there was a strong and positive relationship between students' conscientious intelligence levels and empathy levels [22]. It is seen to support our research result. It is thought that if the conscientious intelligence levels of nurses increase, their empathy levels will also be high and they will understand the patients better and this may be reflected more positively on their care behaviours. It was concluded that empathy levels of nurses had a positive and significant effect on their perceptions of spirituality and spiritual care. In the literature, it is emphasized that spirituality is an all-encompassing concept other than having or not having a religious belief. It is reported that spirituality includes beliefs about health, illness, death, sin, afterlife and responsibility towards others [27], commitment, compassion, empathy, faith, hope, existence, purpose, goal, kinship [45]. The spiritual needs of patients and/or their relatives increase in sudden illness and crisis situations, risk of death or death situations. Spiritual needs; communication, trust, desire to give meaning and purpose to life, hope, forgiveness or forgiveness, love, consolation, coping with the reality of death, hope, prayer and other rituals, people, are defined as spiritually supportive needs. In order to meet these needs, it is very important for nurses to empathise by taking into account culture-specific differences [46]. In addition, it is stated that empathy, active listening, being sensitive to the physical, emotional and spiritual needs and expectations of the patient, knowing the individual's spiritual history, beliefs and the meaning he/she attributes to the disease, and supporting him/her to realize spiritual practices are practices for spiritual care [27]. In a study, it was found that empathy and spirituality are intertwined concepts and that nurses' empathic behaviors stem from their commitment to their spirituality [33]. In a study conducted in Turkey, it was determined that nurses' empathy levels positively affected their spiritual care competencies [47]. Again, in a study conducted by Karagöz on nursing and theology faculty students, it was determined that there was a significant positive relationship between religiosity and empathic tendency and intercultural sensitivity. It was emphasised that the healthcare team should have the ability to have empathy as one of the basic elements in understanding the spiritual world of the patient and realising this on the axis of that person's culture [46]. In this study, it is thought that nurses‘ understanding of their own spiritual world and their perceptions of spirituality and spiritual care are effective in finding a significant relationship between nurses’ empathy level and their perceptions of spirituality and spiritual care. As a result of the findings of our study, it was seen that nurses' conscientious intelligence levels had a positive and significant effect on their perceptions of spirituality and spiritual care. As far as we know, there is no research in the literature that conscientious intelligence affects the perception of spirituality and spiritual care. In a descriptive study, it was determined that nurses used their conscience as a reference while providing care and defined conscience as an expression of social and spiritual values [48]. Conscience is one of the prerequisites for providing basic nursing care. Conscience, which has an important role in providing correct and safe nursing care, is also a prerequisite for ethical behavior. Conscientious intelligence is a power that enables the individual to listen to his/her inner voice and to realize his/her internal and external responsibilities [2]. Therefore, no matter what type of care a nurse provides, her conscience is a tool that will help her provide the best care. According to the results of the analysis testing the mediation effect, empathy level mediates the relationship between conscientious intelligence and perception of spirituality and spiritual care and it is significant. The culture, beliefs, meaning attributed to the disease, diet and preference, reaction to pain, reaction to treatment methods, etc., of each patient that nurses are obliged to care for are different from each other. The conscience of nurses enables them to identify and understand these differences. Empathic approach plays an important role in determining these differences. In the care provided with an empathic approach, the needs of the individual in all dimensions are determined and holistic, ethical and effective nursing care is provided. The provision of spiritual care needs among these dimensions depends on the conscientious intelligence and empathy skills of a nurse. Spiritual care is often ignored for various reasons. There is a common perception among nurses that spiritual needs include only religious beliefs. However, spirituality is a universal construct and a subjective experience. Accordingly, nurses should adhere to ethical principles and moral values to support their conscientious intelligence. They should develop empathy skills and have knowledge and skills in spiritual care. When the international literature was examined, there was no study that determined that empathy mediates the perception of conscientious intelligence and spirituality and spiritual care. In this respect, this research result constitutes the original aspect of the subject. Limitations of the Study The study cannot be generalized to all nurses because it was conducted only with nurses in a training and research hospital within a university. Another limitation of the research is that it was conducted in a certain period of time. Clinical implications of the study Considering the effects of conscientious intelligence in nurses on improving patients' perceptions of spiritual care and the mediating role of empathy, continuous education and support strategies should be implemented in the clinical environment to enhance conscientious intelligence and empathy levels in nurses. Especially in stressful and intense clinical environments, it is important to support nurses with motivational programs aimed at their professional development. This can enhance both their personal and professional growth, ultimately improving the quality of patient care. Through research conducted in clinical settings, the effects of empathy and spiritual care practices on patient outcomes should be regularly monitored and evaluated. Since nurses' empathetic skills and attitudes toward spiritual care can have a significant impact on patient satisfaction, recovery processes, and care quality, it is recommended that research in this area guide clinical decisions. CONCLUSION AND RECOMMENDATIONS Our study showed that conscientious intelligence level of nurses has a significant effect on empathy and spiritual care perception. Based on this finding, it is thought that increasing the level of conscientious intelligence of nurses can improve their empathy skills and this can strengthen their perception of spiritual care. Therefore, providing special trainings to improve nurses' empathy skills may contribute to their being more effective in spiritual care practices. In line with these results, the following recommendations are presented; Educational Programmes : Educational programmes should be organised to help nurses develop conscientious intelligence, self-disciplined thinking and decision-making processes. These programmes may improve nurses' perceptions of spiritual care by increasing their empathy levels. Empathy Development : Increasing the empathy levels of nurses can strengthen their perceptions of spiritual care. In this context, seminars or workshops can be organised to improve empathy. Training for Spirituality : In order to ensure that nurses are more aware and sensitive to the spiritual needs of patients, more training on spirituality and spiritual care can be provided. These trainings can also support the development of nurses' conscientious intelligence skills. Research Development : More research should be conducted on the subject and the effects of conscientious intelligence and empathy on nurses' quality of care should be examined in depth. This type of research may reveal more concrete and applicable results for nursing practice. Declarations Ethics approval and consent to participate Research permission was obtained from the non-interventional ethics committee of Turgut Ozal University (Decision number: 2024/01) and then institutional permission was obtained from the training and research hospital where the research would be conducted. The purpose of the research and ethical issues were notified to the nurses through the data collection form and their verbal and written permissions were obtained before the form was filled. No name-surname was requested in the data collection form and it was stated that the data obtained would not be shared with third persons. The research was conducted in accordance with the Principles of the Declaration of Helsinki. Consent for publication No, the results/data/figures in this manuscript have not been published elsewhere, nor are they under consideration (from you or one of your Contributing Authors) by another publisher. Data availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing Interests I declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Funding No funding support was received from any institution or organization for this research. CRediT authorship contribution statement H.A.: Writing – original draft, Visualization, Software, Resources, Supervision, Formal analysis. S.E.D.: Writing – original draft, Visualization, Software, Resources, Supervision, Formal analysis, A.A.: Writing – original draft, Investigation, Data curation, Conceptualization. Acknowledgements We would like to present our sincere thanks to all the nurses who participated in our research. References Ozcan S. The relationship between nurses’ conscientious intelligence levels and care behaviors: A cross-sectional study. Clin Ethics. 2022;17(2):136–43. https://doi.org/10.1177/1477750921994286 Polat H, Asi Karakaş S, Aslanoğlu E. Conscientious ıntelligence and job motivation in nurses working in psychiatric hospital: a descriptive study. Turkiye Klin J Nurs Sci. 2022;14(3):868–75. DOI:10.5336/nurses.2021-86439 Aktı Ü, Giderler C, Duran C, Behdioğlu S, Boz D. Vicdani zeka ölçeği geçerlilik ve güvenilirlik çalışması. J Islam Civiliz Stud. 2017;2(3):329–49. https://doi.org/10.20486/imad.356480 Arslanoglu A, Tabur A. 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J Pers Soc Psychol. 1986;51(6):1173–82. DOI: 10.1037//0022-3514.51.6.1173 Gunzler D, Chen T, Wu P, Zhang H. Introduction to mediation analysis with structural equation modeling. Shanghai Arch Psychiatry. 2013;25(6):390–4. doi: 10.3969/j.issn.1002-0829.2013.06.009 Boz D, Duran C, Narin İ. . Vicdani zekâ iş performansı. 2019. Gece Akademi. Vicdani zekâ iş performansı. https://www.researchgate.net/publication/332820037 McEwen M. Spiritual nursing care: state of the art. Holist Nurs Pract. 2005;19(4):161–8. DOI: 10.1097/00004650-200507000-00007 Karagöz, S. (2022). Üniversite Öğrencilerinde Dindarlık, Empatik Eğilim ve Kültürlerarası Duyarlılık İlişkisi Üzerine Bir Araştırma. Değerler Eğitimi Dergisi, 20(44), 549-586. https://doi.org/10.34234/ded.1182926 Baysoy K, Ozdemir L. Examining the relationship between nurses’ spiritual care competence levels and empathy, compassion and workload levels. Ankara: Oncology Nursing Congress 20-22 October; 2022 p. 1–4. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5895594","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":437557416,"identity":"c771a285-d18f-41ef-bb26-05a34e61255b","order_by":0,"name":"Seçil ERGİN DOĞAN","email":"","orcid":"","institution":"Inonu University","correspondingAuthor":false,"prefix":"","firstName":"Seçil","middleName":"ERGİN","lastName":"DOĞAN","suffix":""},{"id":437557417,"identity":"ac159269-4dfd-4974-9bc0-5c292c298527","order_by":1,"name":"Hakime Aslan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYBACAwY2hgNgFjsQfzCACvMQpYWZgYFxBpIWCXxaGGBamOGG49Nizn4s8dCNCgZ5+WbmZ49tCu7ImUskMD5428ZQZ96AXYtlT9qBwzlnGAw3HGYzN84xeGZsOSOB2XBuG4OEzAEcDjuQ3nA4t42BcQMzg5l0jsHhxA03EtikeYFacLnM4PxzoJZ/DPbzm9m/SVtAtLD/xqvlBtBhuQ0MiQ2HecykGaC2MOPX8izhcM4xieQNh3nKJHsMDhsbnHnYLDnnnITkDJwOSzP+nFNjYzu/vX2bxI8/h+UMjicf/PCmzIYfZyhDAIo0YwO6yCgYBaNgFIwCEgEA5KBWu6DeZ5EAAAAASUVORK5CYII=","orcid":"","institution":"Inonu University","correspondingAuthor":true,"prefix":"","firstName":"Hakime","middleName":"","lastName":"Aslan","suffix":""},{"id":437557418,"identity":"3e49d153-84f3-4905-8aa4-17f3dd1024bc","order_by":2,"name":"Abdurrahman Akçin","email":"","orcid":"","institution":"Turgut Ozal University","correspondingAuthor":false,"prefix":"","firstName":"Abdurrahman","middleName":"","lastName":"Akçin","suffix":""}],"badges":[],"createdAt":"2025-01-24 12:23:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5895594/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5895594/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-025-03468-0","type":"published","date":"2025-07-03T15:57:12+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79847532,"identity":"8bc1e151-1ad5-429d-9c9f-8405a7f54144","added_by":"auto","created_at":"2025-04-03 14:03:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":51338,"visible":true,"origin":"","legend":"\u003cp\u003eResearch Model\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5895594/v1/cdd203df9d45d56a0eac707e.png"},{"id":79848504,"identity":"fcb4d8eb-1467-443e-92d5-6d30e59b92e2","added_by":"auto","created_at":"2025-04-03 14:11:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":245464,"visible":true,"origin":"","legend":"\u003cp\u003eDimensions and Items in the First Structural Equation Model\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5895594/v1/97584334db0b58458b133a92.png"},{"id":79850325,"identity":"3d91911e-56ad-4294-8029-e0227d078cdc","added_by":"auto","created_at":"2025-04-03 14:27:17","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":279492,"visible":true,"origin":"","legend":"\u003cp\u003eDimensions and Items in the Second Structural Equation Model\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5895594/v1/5a5dd0fe147c4d5343b2794f.png"},{"id":86178930,"identity":"a841bea0-850a-4109-a37d-469beee1c9e4","added_by":"auto","created_at":"2025-07-07 16:11:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1673666,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5895594/v1/f7f718e2-d3ea-47c5-8f96-179ba97687a8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The mediating role of empathy in relationships between conscientious intelligence and perceptions of spiritual care among Turkish nurses; A structural equation modelling","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eNursing is a profession based on human needs and the only task that has not changed throughout history is care, which is the basis of nursing practices [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. While providing care, nurses have to make the right decision in order not to harm human health and dignity. Nurses' conscience is a prerequisite for them to make the most ethically correct decision and provide care [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Conscience is a feeling that leads a person to be in favor of doing good, to reject evil and to be uneasy with evil, and is an emotion that constantly judges. It is also the ability to morally judge one's conscious actions and the level of understanding of what is right or wrong [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. For nurses to provide effective care and protect their own health, intelligence, which is the ability to solve problems, is important as well as the ability of conscience to make the right decision [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Intelligence is all human abilities of thinking, reasoning, perceiving objective facts, judging and drawing conclusions, comprehension, intelligence and heredity [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In the information age, a different dimension was brought to the concept of intelligence, and the concept of 'conscientious intelligence' emerged by using conscience and intelligence together [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConscientious intelligence, also known as spiritual intelligence, is listening to one's inner voice and being aware of one's internal and external responsibilities [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Listening to the inner voice, being aware of internal and external responsibilities, responsibility towards the creator, accountability, having ethical values, reasoning, being humble, having principles, wisdom and honesty constitute the values of conscientious intelligence [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Tarhan (2012) defines conscientious intelligence as the ability to act in awareness of one's responsibilities and at an internal level of consciousness [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Conscientious intelligence forms a whole with dimensions such as inner voice listening, corresponding to internal and external responsibility, accountability, and acting according to moral values, which include one's responsibility towards oneself and others [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Conscientious intelligence is based on conscientious values [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It is anticipated that in organizations where individuals act according to conscientious values, activities will be conducted for the benefit of all stakeholders [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. It is inevitable that nurses, who constitute an important component of health care systems, acting according to conscientious values will provide significant benefits to the health system [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Conscientious values help nurses to provide quality and honourable care, to be understanding and careful in care delivery, reduce errors, encourage the protection of patient rights, and play an important role in decision-making, informing and guiding professional practices [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In studies conducted in Turkey, it has been determined that conscientious intelligence is also effective in increasing nurses' work motivation and managing patient expectations [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. For these reasons, conscientious intelligence, which originates from conscientious values, has a very important place in nurses [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It has been stated that the high level of conscientious intelligence of nurses will enable them to solve their problems conscientiously, improve themselves by adopting a conscientious approach, and achieve prosperity and happiness [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In addition to nurses' own happiness, it has also been determined that the development of conscientious intelligence can help nurses to improve their creativity, productivity, versatility and communication skills for the benefit of patients [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In addition to the conscientious intelligence of nurses, their level of empathy is also very important in fully meeting patient needs, increasing satisfaction and maintaining healthy communication. Patients from different cultures have different health conditions such as nutrition, pain, tendency to alternative treatment methods, health-disease perceptions, and body language use. Conscience enables us to understand and respect these differences and the different values of patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The nurse should demonstrate an empathic approach to detect differences. Empathy in nursing is defined as the ability to fully understand and share the patient's feelings and thoughts by establishing healthy communication with evidence-based constructive approaches. Shared understanding based on empathic communication complements useful data for planning individualized care that encourages patients to actively regulate their health [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Empathy, caring, compassion and personal characteristics of the nurse are indicators of a value that is fundamental to the professional identity and ideology of nursing [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In order for the nurse to assist the patient they are caring for, it is essential for them to first reach out to the patient, show respect, try to understand them, engage with them, be aware of their needs, and maintain a relationship based on trust. A nurse can only reach the patient through communication knowledge and skills. At this point, while the nurse forms the foundation of care with an empathetic understanding, they also take the patient's culture into account when addressing individual needs effectively. The nurse reflects the importance of cultural values, beliefs, practices, and attitudes in the foundation of care and demonstrates a holistic and humanistic approach to care by using the ability to empathize [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Holistic nursing care is a special nursing practice that argues that body, mind, spirit, emotions, environment, relationships and social and cultural aspects of life are interconnected and should be handled as a whole [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Holistic nurses should be able to use their intuition in addition to knowledge, theory, expertise and experience in order to provide care to the patient as a whole in the healing process of the patient [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In addition, they should maintain holistic communication, respect cultural diversity and show an empathic approach by accepting differences. Thus, a real holistic nursing care can be mentioned [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhen we look at the definitions of the concepts of conscience and empathy, which emphasize the spiritual aspect of human beings, it is seen that they are intertwined concepts [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In addition, a nurse's ability to exhibit empathic behaviors depends on her/his spirituality [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. According to the holistic approach, the individual is a whole with physical, emotional, mental, social, cultural and spiritual aspects. To protect and maintain the integrity of a person, spiritual needs must be met in addition to all their needs [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Spirituality is the life force in the individual, the search for the meaning and purpose of life, being in a relationship with the creator, healing through prayer, faith and meditation, and a sense of well-being through inner peace [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Spirituality can be defined as a broader and more universal construct than religiosity; spirituality is framed as a subjective experience that can exist both inside and outside a religious framework [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Spirituality plays a holistic and unifying role in medical and social services and plays an important role in helping people to regain their health, or if this is not possible, to face the current situation and maintain their connections with life [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Ethical and effective nursing care should respect the patient's spirituality and religiosity. Given this imperative, nurses are increasingly expected to provide spiritual care that assesses and addresses the spiritual distress and challenges of patients and families [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Spirituality-oriented nursing care includes diagnosing the spiritual needs of the individual, planning interventions for these needs, implementing interventions, as well as supporting the individual and evaluating the care [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Active listening and empathic approach, recognizing the spiritual, physical and emotional needs of the patient, supporting the patient's beliefs, the meaning attributed to the disease, spiritual history and religious practices are the practices that constitute spiritual nursing care [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, nurses face some obstacles in providing spiritual care, such as insufficient time, lack of training, and the belief that spirituality is a private subject and that nurses should not enter this subject. Due to these obstacles, the frequency of nurses providing spiritual care decreases [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConscientious intelligence has emerged as a result of the integration of intelligence with spirituality. The spiritual nature of man constitutes a motivation, the direction of which depends on human knowledge and reason. While recognising the similarity and integration between religion and spirituality, there is also a consensus on the differences and distinctions between them; religion focuses on the sacred, while spirituality points to meaning, sublimity and perfection [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In general terms, it is a known reality that the common goal of all religions is to bring peace and happiness to humanity on an individual and social basis and that they preach many universal human values and principles to achieve this goal. In this context, it is possible to state that the components of conscientious intelligence such as empathy, moral judgement, sense of justice, responsibility, respect, honesty and benevolence are also recognised and attributed importance as universal human values in religions. In this respect, it is possible to say that there are common denominators between spirituality and conscientious intelligence [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In the literature, it has been observed that some studies have been conducted on how to establish a relationship between conscientious intelligence and spirituality. For example, in the research conducted by Karakaş, it was determined that there was a positive relationship between spiritual intelligence and religiosity and flexibility of forgiveness [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Asıcı also found a positive relationship between emotional intelligence and forgiveness [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. \u0026Ouml;zcan et al., also determined that there was a positive relationship between nurses' conscientious intelligence levels and care behaviours [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In these studies, it is seen that there are significant relationships between religion and spirituality and relationship intelligences and conscientious values. Based on this context, it was inevitable to address the relationship between nurses' conscientious intelligence and their perceptions of spiritual care.\u003c/p\u003e \u003cp\u003eIn the literature, it has been observed that there is a significant relationship between conscientious intelligence and empathy level, and there is a strong link between conscientious intelligence and spirituality in the context of values. However, in the literature search, it was observed that the studies evaluating the effect of nurses' conscientious intelligence levels on patient care outcomes were very limited. It is essential to investigate the positive results of conscience, which has an important place in nursing care, and to integrate it into nursing education. Based on this scope, this study was conducted to evaluate the relationship between nurses' conscientious intelligence levels and their perceptions of empathy and spiritual care.\u003c/p\u003e \u003cp\u003eThe hypotheses for the research were formed as follows;\u003c/p\u003e \u003cp\u003eH\u003csub\u003e1\u003c/sub\u003e: There is a relationship between nurses' conscientious intelligence levels and empathy levels.\u003c/p\u003e \u003cp\u003eH\u003csub\u003e2\u003c/sub\u003e: There is a relationship between nurses' empathy levels and their perceptions of spirituality and spiritual care.\u003c/p\u003e \u003cp\u003eH\u003csub\u003e3\u003c/sub\u003e: There is a relationship between nurses' levels of conscientious intelligence and their perceptions of spirituality and spiritual care.\u003c/p\u003e \u003cp\u003eH\u003csub\u003e4\u003c/sub\u003e: Empathy level mediates the relationship between nurses' levels of conscientious intelligence and their perceptions of spirituality and spiritual care.\u003c/p\u003e \u003cp\u003eThe research model and hypothesis were formed as follows;\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThe research is cross-sectional type.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and sampling\u003c/h3\u003e\n\u003cp\u003eThis study was conducted between January and April 2024. The population of the study consisted of nurses working in a training and research hospital located in the Eastern Anatolia Region of Turkey. All nurses working in the relevant hospital constituted the population of the study (N: 1040). The sample consisted of 314 nurses determined by using G Power 3.1.9.7 programme (0.20 effect size and 0.05 margin of error and 95% confidence interval). Nurses were selected from the population using simple random sampling method. The nurses were informed about the study and asked to fill out the data collection forms completely. A total of 315 nurses who volunteered to participate in the study and completed the data collection forms completely were included in the study.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInclusion- Exclusion criteria\u003c/strong\u003e \u003cp\u003eAll nurses who had been working as a nurse for at least 3 months and who agreed to participate in the study were included in the study. Nurses working in the operating theatre were not included in the study due to the protection of sterile environment and lack of patient communication.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe nurses working in the operating theatre were excluded from the sample because the patient-nurse relationship is very limited and the interaction with patients is very limited compared to nurses working in other units. As a result, including them in the sample could have diluted the study's focus on the patient-nurserelationship and patient outcomes. However, excluding operating theatre nurses may also impact the generalizability of the study's findings. By not including a broader range of nursing roles that interact with patients in different contexts, the sample may not fully represent the diversity of nursing experiences across healthcare settings. This exclusion limits the ability to apply the study\u0026rsquo;s results universally to all nursing contexts, particularly in areas where nurses play a pivotal role in patient care throughout the entire treatment process, including during surgery.\u003c/p\u003e \u003cp\u003eThe impact on generalizability also extends to the potential differences in how patient care is delivered in the operating room versus other settings. Operating theatre nurses have unique skills and responsibilities that could influence patient outcomes in ways that are not captured by the study. Therefore, while the study design benefits from a more focused sample, the exclusion of operating theatre nurses reduces the representativeness of the findings in a broader nursing context.\u003c/p\u003e\n\u003ch3\u003eData Collection and Instruments\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eProcedure\u003c/strong\u003e \u003cp\u003eThe researcher started the data collection process after obtaining institutional permission from the relevant hospital. To collect data, the researcher went to the hospital, provided the necessary explanations about the research, and obtained informed consent from the nurses. The researcher left as many survey forms as there were nurses working in the ward and then moved on to other clinics. The completed data collection forms were collected again in the evening. At the beginning of working hours, data collection forms were distributed to the nurses and collected at the end of working hours.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe 'Personal Information Form,' consisting of questions related to age, gender, years of work experience, etc., which were determined based on the literature to identify the socio-demographic characteristics of nurses, as well as the The Conscientious Intelligence Scale (CIS)' Empathy Quotient Scale (EQS),' and Spirituality and Spiritual Care Rating Scale (SSCRS)' were used to collect data\u003c/p\u003e\n\u003ch3\u003ePersonal Information Form\u003c/h3\u003e\n\u003cp\u003eIt is a data collection tool consisting of eight questions (age, gender, educational status, years of employment, marital status, having children, satisfaction with the nursing profession) developed by the researchers.\u003c/p\u003e\n\u003ch3\u003eThe Conscientious Intelligence Scale (CIS)\u003c/h3\u003e\n\u003cp\u003eIt was developed by Aktı et al., (2017) to determine the level of conscientious intelligence of nurses. In the 5-point Likert-type scale, conscientious intelligence consists of a 7-factor structure including \u0026ldquo;ethical values\u0026rdquo;, \u0026ldquo;moral sensitivity\u0026rdquo;, \u0026ldquo;responsibility towards the creator\u0026rdquo;, \u0026ldquo;compassion\u0026rdquo;, \u0026ldquo;conscious awareness\u0026rdquo;, \u0026ldquo;social sensitivity\u0026rdquo; and \u0026ldquo;wisdom\u0026rdquo;. CIS consists of 32 items. These items are scored as \u0026ldquo;strongly disagree\u0026rdquo; (1 point), \u0026ldquo;disagree\u0026rdquo; (2 points), \u0026ldquo;undecided\u0026rdquo; (3 points), \u0026ldquo;agree\u0026rdquo; (4 points), \u0026ldquo;strongly agree\u0026rdquo; (5 points). The lowest score that can be obtained from this scale is 32, while the highest score is 160. Questions 1, 2, 3, 4 and 5 are reverse coded. In the development study of the scale, Cronbach's alpha coefficient for the total score of the CIS was determined as 0.85 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In this study Chronbach\u0026rsquo;s alpha value was 0.85.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEmpathy Quotient Scale (EQS)\u003c/h2\u003e \u003cp\u003eIt is a measurement tool that was adapted into Turkish by Barış and \u0026Ccedil;olakoğlu (2015) and validity and reliability study was conducted to determine the empathy level of nurses. The EQS consists of 13 items and 3 sub-dimensions. The sub-dimensions are categorized as Cognitive Empathy, Emotional Reaction and Social Skills. The scale has a 5-point Likert-type rating as \u0026ldquo;1\u0026rdquo; Strongly Disagree, \u0026ldquo;2\u0026rdquo; Disagree, \u0026ldquo;3\u0026rdquo; Undecided, \u0026ldquo;4\u0026rdquo; Agree and \u0026ldquo;5\u0026rdquo; Strongly Agree. Cronbach's alpha coefficient of EQS was determined as 0.78 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In this study Chronbach\u0026rsquo;s alpha value was 0.76.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSpirituality and Spiritual Care Rating Scale (SSCRS)\u003c/h3\u003e\n\u003cp\u003e In order to determine nurses' perception of spirituality and spiritual care, Erg\u0026uuml;l and Bayık Temel [2007] adapted the scale into Turkish and conducted a validity and reliability study. The scale includes a total of 17 questions and consists of \u0026ldquo;spirituality and spiritual care\u0026rdquo; (item 6,7,8,9,11,12,14), \u0026ldquo;religiosity\u0026rdquo; (item 4,5,13,16) and \u0026ldquo;individual care\u0026rdquo; (item 1,2,10,15) sub-dimensions. The items are scored from 1, which means \u0026ldquo;strongly disagree\u0026rdquo;, to 5, which means \u0026ldquo;strongly agree\u0026rdquo;. The first 13 items are scored straight and the last four items are scored in reverse. As the average total score increases, the level of perception of the concepts of spirituality and spiritual care increases positively. Accordingly, the highest score that can be obtained from the spirituality and spiritual care sub-dimension is 31, and 16 from the religiosity and individual care sub-dimensions. The highest score that can be obtained from the total scale is 69. Cronbach's alpha coefficient for the total score of the SSCRS was determined as 0.76 [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In this study Chronbach\u0026rsquo;s alpha value was 0.73.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe data obtained were coded and entered into the IBM SPSS.25 (IBM Corp., Armonk, New York, USA) package program. Descriptive statistics (frequency and percentage) were made and it was analyzed whether the scale mean scores fit the normal distribution. As a result of the Kolmogorov Smirnov test, it was determined that the data fit the normal distribution and there was no missing data. Since the normal distribution was found, a model for the hypotheses was created in the IBM SPSS AMOS version 26 program and these hypotheses were tested.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEthical Consideration\u003c/h2\u003e \u003cp\u003e Research permission was obtained from the non-interventional ethics committee of Turgut Ozal University and then institutional permission was obtained from the training and research hospital where the research would be conducted (Decision number: 2024/01). The purpose of the study and ethical issues were informed to the nurses through the data collection form and their verbal and written permissions were obtained before the form was filled. Verbal/written informed consent was obtained from all of the participants in the study. They were informed that they could withdraw from the study at any time. Name and surname were not requested in the data collection form and it was stated that the data obtained would not be shared with third parties.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe sociodemographic data of the participants in the study are given in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. As seen in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the majority of the nurses who participated in the study were female nurses. In addition, the highest number of participants were between the ages of 18\u0026ndash;24, bachelor's degree, 1\u0026ndash;5 years in the profession, married and satisfied with their profession (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eSociodemographic Data of the Participants (N\u0026thinsp;=\u0026thinsp;315)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSocio-demographic variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88,9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11,1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e18\u0026ndash;24\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e25\u0026ndash;30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27,9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e31\u0026ndash;35\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e36\u0026ndash;40\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6,3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e41\u0026ndash;45\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e46 and above\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8,9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHigh School\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAssociate Degree\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8,6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBachelor\u0026rsquo;s Degree\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e81,6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMaster's Degree\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4,4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePhD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eYears in the Profession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1\u0026ndash;5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49,2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e6\u0026ndash;10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e11\u0026ndash;15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e16\u0026ndash;20\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e21 and above\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19,7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMarried\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSingle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSatisfaction with Nursing Profession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66,3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33,7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eInvestigation of the Measurement Model\u003c/h2\u003e \u003cp\u003eAt this stage of the study, in order to establish the SEM in a healthier way, firstly, a restricted factor analysis, also known as confirmatory factor analysis (CFA), was applied to determine the scale validity for each dimension (EQS, CIS and SSCRS) in the study.\u003c/p\u003e \u003cp\u003eIn short, linear factor analysis is a SEM that examines the relationships between latent variables and indicators. The purpose of linear factor analysis is to estimate indicator error variances, factor loadings, factor covariances and variances, indicator error variances and covariances, in short, the variance covariance matrix that is most similar to the sample variance covariance matrix for each parameter in the measurement model [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to the results of the linear factor analysis applied for each dimension, most of the goodness-of-fit indices were within the acceptance limits and the highly erroneous items that negatively affected the fit between the data and the model, the causal relationships between the data or the normal distribution of the data were removed from the model and covariances between some variables were created. The goodness of fit values after the modification improvements are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eModel Measurement Values for Each Dimension\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel Fit Measures\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEQS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCIS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSSCRS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eχ2/df\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.939\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.749\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.904\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.902\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.938\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRMR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRMSEA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSRMR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0570\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eχ2: Chi-Square Value, df: Degrees of Freedom Value, CFI: Comperative Fix Index, GFI: Goodness of Fix Index, RMR: Root Mean Square Resiual, RMSEA: Root Mean Square Error of Approximation, SRMR: Standardized Root Mean Square Residual.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere are certain value ranges for the indices used in the evaluation of model fit. The \u003cem\u003eχ2/df\u003c/em\u003e ratio between 0.1 and 3 is considered appropriate and this ratio is within the specified value ranges for each dimension used in the study [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. \u003cem\u003eCFI\u003c/em\u003e and \u003cem\u003eGFI\u003c/em\u003e indices between 0.80 and 0.90 are generally accepted and values above 0.90 indicate good fit [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. For each dimension, a ratio above 0.90 indicates good fit. Another index, the \u003cem\u003eRMR\u003c/em\u003e index, should be between 0\u0026ndash;1 and a value less than 0.05 indicates good fit [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. For each dimension, this value is within the specified value ranges. The \u003cem\u003eRMSEA\u003c/em\u003e index between 0.05\u0026ndash;0.08 indicates good fit and these values for each dimension are within the specified value ranges [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Finally, the \u003cem\u003eSRMR\u003c/em\u003e index should be less than or equal to 0.08. For each dimension, this value being below 0.08 indicates good fit [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAfter it was determined that the measurement models fit the data as a result of the linear factor analysis performed separately for each dimension, linear factor analysis was applied to the first model in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for the mediator variable analysis to be investigated in hypothesis H\u003csub\u003e4\u003c/sub\u003e with structural equation modeling and to the second model in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, which includes all dimensions together to investigate hypotheses H\u003csub\u003e1\u003c/sub\u003e, H\u003csub\u003e2\u003c/sub\u003e and H\u003csub\u003e3\u003c/sub\u003e. The goodness of fit values of the research models are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eMeasurement Values of the Research Model\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel Fit Measures\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst Model Fit Values\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSecond Model Fit Values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eχ2/df\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.984\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.104\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.814\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.785\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRMR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRMSEA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSRMR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0770\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0812\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eχ2: Chi-Square Value, df: Degrees of Freedom Value, CFI: Comperative Fix Index, GFI: Goodness of Fix Index, RMR: Root Mean Square Resiual, RMSEA: Root Mean Square Error of Approximation, SRMR: Standardized Root Mean Square Residual.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen the first model fit indices were examined, \u003cem\u003eχ2/df\u003c/em\u003e, \u003cem\u003eCFI\u003c/em\u003e, \u003cem\u003eGFI\u003c/em\u003e, \u003cem\u003eRMR\u003c/em\u003e were within the acceptance limits and good model fit was determined for \u003cem\u003eRMSEA\u003c/em\u003e and \u003cem\u003eSRMR\u003c/em\u003e. When the second model fit indices were examined, \u003cem\u003eχ2/df\u003c/em\u003e, \u003cem\u003eCFI\u003c/em\u003e, \u003cem\u003eRMR\u003c/em\u003e were within the acceptance limits and good model fit was determined for \u003cem\u003eRMSEA\u003c/em\u003e and \u003cem\u003eSRMR\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eInvestigation of Structural Equation Model\u003c/h2\u003e \u003cp\u003eStructural equation modeling (SEM), which is based on the identification of observable and unobservable (latent) variables with causal relationships, represents the investigated causal relationships with structural equations, i.e. regressions. These structural relationships are modeled in a comprehensive and systematic way and presented to the researcher visually [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe mediating variable analysis is tested with the three-stage regression analysis proposed by Baron and Kenny (1986) [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. These are respectively, for this research, the level of conscientious intelligence, which is the independent variable, has a significant effect on the perception of spirituality and spiritual care, which is the dependent variable; the level of empathy, which is the mediating variable, has a significant effect on the perception of spirituality and spiritual care; and when the level of empathy is included in the regression analysis in the second stage, the effect of conscientious intelligence on the perception of spirituality and spiritual care decreases, while the level of empathy has a significant effect on the perception of spirituality and spiritual care. SEM provides a more appropriate inference framework for mediation analyses and other types of causal analysis [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. For these reasons, in this study, the mediating variable analysis investigating hypothesis H\u003csub\u003e4\u003c/sub\u003e was tried to be determined by SEM. Two separate models were established to investigate the stated effects. The first structural equation model in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e investigates whether CIS, the independent variable, has a significant effect on SSCRS, the dependent variable, and the second structural equation model in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e investigates whether there is a significant relationship between CIS and EQS; between EQS and SSCRS; and between CIS and SSCRS. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the hypothesis test results of structural equation modeling.\u003c/p\u003e \u003cp\u003eIn the first model, SSCRS was selected as the dependent variable and CIS was selected as the independent variable. The path coefficient between SSCRS and CIS was found to be significant (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}_{1}\\)\u003c/span\u003e\u003c/span\u003e:0.361, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and nurses' conscientious intelligence levels had a positive and significant effect on their perceptions of spirituality and spiritual care (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eRegression Weight Values for the First and Second Models\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eTested Path\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\varvec{\\beta\\:}}_{1}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\varvec{\\beta\\:}}_{2}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eS.E.\u003c/p\u003e \u003cp\u003e(Standard Error)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eC.R.\u003c/p\u003e \u003cp\u003e(Critical Rate)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP\u003c/p\u003e \u003cp\u003e(Sig.)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSSCRS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;---\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eCIS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,684\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6,443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTested Path\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\varvec{\\beta\\:}}_{1}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\varvec{\\beta\\:}}_{2}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eS.E.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Standard Error)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eC.R.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Critical Rate)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eP\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Sig.)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEQS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;---\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eCIS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0,005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSSCRS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;---\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eCIS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5,67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSSCRS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;---\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eEQS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5,346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\varvec{\\beta\\:}}_{1}\\)\u003c/span\u003e\u003c/span\u003e: Standardized estimates, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\varvec{\\beta\\:}}_{2}:\\)\u003c/span\u003e\u003c/span\u003e Unstandardized estimates, SE.:Standard Error, CR.: Critical Rate, p: Signifigence, ***\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0,001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAccording to the test results of the 2nd and 3rd stages of the mediating variable analysis, the path coefficient between CIS and EQS representing hypothesis H\u003csub\u003e1\u003c/sub\u003e was found to be significant (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}_{1}\\)\u003c/span\u003e\u003c/span\u003e:0.169, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005), and it was determined that nurses' conscientious intelligence levels had a positive and significant effect on their empathy levels.\u003c/p\u003e \u003cp\u003eThe path coefficient between EQS and SSCRS representing hypothesis H\u003csub\u003e2\u003c/sub\u003e was found significant (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}_{1}\\)\u003c/span\u003e\u003c/span\u003e:0.304, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and it was concluded that nurses' empathy levels have a positive and significant effect on their perceptions of spirituality and spiritual care.\u003c/p\u003e \u003cp\u003eFinally, the path coefficient between CIS and SSCRS representing hypothesis H\u003csub\u003e3\u003c/sub\u003e was found to be significant (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}_{1}\\)\u003c/span\u003e\u003c/span\u003e:0.311, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and it was seen that nurses' conscientious intelligence levels had a positive and significant effect on their perceptions of spirituality and spiritual care. All this information indicates that EQS may be a mediating variable (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFinally, the results of the analysis that allows us to test the mediating effect of CIS on SSCRS through EQS are shown in the standardized indirect effects results table in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eSince the Two Tailed Significance value is 0.02 and below the 95% confidence interval, the mediation effect can be mentioned. In other words, EQS mediates the relationship between CIS and SSCRS, which represents hypothesis H\u003csub\u003e4\u003c/sub\u003e, and it is significant. In addition, the decrease in the coefficient of CIS in model 2, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}_{1}\\)\u003c/span\u003e\u003c/span\u003e (0.311), compared to the coefficient of CIS in model 1, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}_{1}\\)\u003c/span\u003e\u003c/span\u003e (0.361), means that CIS affects SSCRS through EQS. It is also seen that the coefficient of this mediating effect is in the range of Lower Bounds value 0.017 and Upper Bounds value 0.092 (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eStandardized Indirect Effects Results\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStandardized Indirect Effects\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoyutlar\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCIS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEQS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSSCRS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLower Bounds\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSSCRS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUpper Bounds\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSSCRS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTwo Tailed Significance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSSCRS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0,02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, the relationship between conscientious intelligence levels, empathy and spiritual care perceptions of 315 nurses was investigated. In this study, we determined that the conscientious intelligence levels of nurses had a positive and significant effect on their empathy levels. People try to search for the meaning and significance of their behaviour and the questions they cannot answer. In fact, this search is a situation that people can learn through their own skills and even through the ways they will remember by evaluating them in the form of conscientiousness and empathy\u0026nbsp;[22]. In addition to seeking answers to the questions they are looking for with their conscience and using empathy, people have also tried to come to a conclusion with the criticism of others by evaluating whether it is appropriate in terms of moral values\u0026nbsp;[44]. Nurses who aim to provide holistic care to patients are expected to have developed levels of conscientious intelligence and high levels of empathy in order to respond to the problems and needs of patients. In the literature, there is no research on the relationship between conscientious intelligence and empathy level in nurses. However, in a study conducted on athlete students, it was found that there was a strong and positive relationship between students' conscientious intelligence levels and empathy levels\u0026nbsp;[22]. It is seen to support our research result. It is thought that if the conscientious intelligence levels of nurses increase, their empathy levels will also be high and they will understand the patients better and this may be reflected more positively on their care behaviours.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt was concluded that empathy levels of nurses had a positive and significant effect on their perceptions of spirituality and spiritual care. In the literature, it is emphasized that spirituality is an all-encompassing concept other than having or not having a religious belief. It is reported that spirituality includes beliefs about health, illness, death, sin, afterlife and responsibility towards others [27], commitment, compassion, empathy, faith, hope, existence, purpose, goal, kinship [45]. The spiritual needs of patients and/or their relatives increase in sudden illness and crisis situations, risk of death or death situations. Spiritual needs; communication, trust, desire to give meaning and purpose to life, hope, forgiveness or forgiveness, love, consolation, coping with the reality of death, hope, prayer and other rituals, people, are defined as spiritually supportive needs. In order to meet these needs, it is very important for nurses to empathise by taking into account culture-specific differences [46].\u0026nbsp;In addition, it is stated that empathy, active listening, being sensitive to the physical, emotional and spiritual needs and expectations of the patient, knowing the individual's spiritual history, beliefs and the meaning he/she attributes to the disease, and supporting him/her to realize spiritual practices are practices for spiritual care\u0026nbsp;[27].\u0026nbsp;\u0026nbsp;In a study, it was found that empathy and spirituality are intertwined concepts and that nurses' empathic behaviors stem from their commitment to their spirituality\u0026nbsp;[33]. In a study conducted in Turkey, it was determined that nurses' empathy levels positively affected their spiritual care competencies\u0026nbsp;[47]. Again, in a study conducted by Karagöz on nursing and theology faculty students, it was determined that there was a significant positive relationship between religiosity and empathic tendency and intercultural sensitivity.\u0026nbsp;It was emphasised that the healthcare team should have the ability to have empathy as one of the basic elements in understanding the spiritual world of the patient and realising this on the axis of that person's culture\u0026nbsp;[46].\u0026nbsp;\u0026nbsp;In this study, it is thought that nurses‘ understanding of their own spiritual world and their perceptions of spirituality and spiritual care are effective in finding a significant relationship between nurses’ empathy level and their perceptions of spirituality and spiritual care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs a result of the findings of our study, it was seen that nurses' conscientious intelligence levels had a positive and significant effect on their perceptions of spirituality and spiritual care. As far as we know, there is no research in the literature that conscientious intelligence affects the perception of spirituality and spiritual care. In a descriptive study, it was determined that nurses used their conscience as a reference while providing care and defined conscience as an expression of social and spiritual values [48]. Conscience is one of the prerequisites for providing basic nursing care. Conscience, which has an important role in providing correct and safe nursing care, is also a prerequisite for ethical behavior. Conscientious intelligence is a power that enables the individual to listen to his/her inner voice and to realize his/her internal and external responsibilities [2]. Therefore, no matter what type of care a nurse provides, her conscience is a tool that will help her provide the best care.\u003c/p\u003e\n\u003cp\u003eAccording to the results of the analysis testing the mediation effect, empathy level mediates the relationship between conscientious intelligence and perception of spirituality and spiritual care and it is significant. The culture, beliefs, meaning attributed to the disease, diet and preference, reaction to pain, reaction to treatment methods, etc., of each patient that nurses are obliged to care for are different from each other. The conscience of nurses enables them to identify and understand these differences. \u0026nbsp;Empathic approach plays an important role in determining these differences. In the care provided with an empathic approach, the needs of the individual in all dimensions are determined and holistic, ethical and effective nursing care is provided. The provision of spiritual care needs among these dimensions depends on the conscientious intelligence and empathy skills of a nurse. Spiritual care is often ignored for various reasons. There is a common perception among nurses that spiritual needs include only religious beliefs. However, spirituality is a universal construct and a subjective experience. Accordingly, nurses should adhere to ethical principles and moral values to support their conscientious intelligence. They should develop empathy skills and have knowledge and skills in spiritual care. When the international literature was examined, there was no study that determined that empathy mediates the perception of conscientious intelligence and spirituality and spiritual care. In this respect, this research result constitutes the original aspect of the subject.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study cannot be generalized to all nurses because it was conducted only with nurses in a training and research hospital within a university. Another limitation of the research is that it was conducted in a certain period of time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical implications of the study\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsidering the effects of conscientious intelligence in nurses on improving patients' perceptions of spiritual care and the mediating role of empathy, continuous education and support strategies should be implemented in the clinical environment to enhance conscientious intelligence and empathy levels in nurses. Especially in stressful and intense clinical environments, it is important to support nurses with motivational programs aimed at their professional development. This can enhance both their personal and professional growth, ultimately improving the quality of patient care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThrough research conducted in clinical settings, the effects of empathy and spiritual care practices on patient outcomes should be regularly monitored and evaluated. Since nurses' empathetic skills and attitudes toward spiritual care can have a significant impact on patient satisfaction, recovery processes, and care quality, it is recommended that research in this area guide clinical decisions.\u003c/p\u003e"},{"header":"CONCLUSION AND RECOMMENDATIONS ","content":"\u003cp\u003eOur study showed that conscientious intelligence level of nurses has a significant effect on empathy and spiritual care perception. Based on this finding, it is thought that increasing the level of conscientious intelligence of nurses can improve their empathy skills and this can strengthen their perception of spiritual care. Therefore, providing special trainings to improve nurses' empathy skills may contribute to their being more effective in spiritual care practices.\u003c/p\u003e\n\u003cp\u003eIn line with these results, the following recommendations are presented;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEducational Programmes\u003c/em\u003e\u003c/strong\u003e: Educational programmes should be organised to help nurses develop conscientious intelligence, self-disciplined thinking and decision-making processes. These programmes may improve nurses' perceptions of spiritual care by increasing their empathy levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEmpathy Development\u003c/em\u003e\u003c/strong\u003e: Increasing the empathy levels of nurses can strengthen their perceptions of spiritual care. In this context, seminars or workshops can be organised to improve empathy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTraining for Spirituality\u003c/em\u003e\u003c/strong\u003e: In order to ensure that nurses are more aware and sensitive to the spiritual needs of patients, more training on spirituality and spiritual care can be provided. These trainings can also support the development of nurses' conscientious intelligence skills.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eResearch Development\u003c/em\u003e\u003c/strong\u003e: More research should be conducted on the subject and the effects of conscientious intelligence and empathy on nurses' quality of care should be examined in depth. This type of research may reveal more concrete and applicable results for nursing practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch permission was obtained from the non-interventional ethics committee of Turgut Ozal University (Decision number: 2024/01) and then institutional permission was obtained from the training and research hospital where the research would be conducted. The purpose of the research and ethical issues were notified to the nurses through the data collection form and their verbal and written permissions were obtained before the form was filled. No name-surname was requested in the data collection form and it was stated that the data obtained would not be shared with third persons. The research was conducted in accordance with the Principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo, the results/data/figures in this manuscript have not been published elsewhere, nor are they under consideration (from you or one of your Contributing Authors) by another publisher.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding support was received from any institution or organization for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCRediT authorship contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH.A.:\u003c/strong\u003e Writing – original draft, Visualization, Software, Resources, Supervision, Formal analysis. \u003cstrong\u003eS.E.D.:\u003c/strong\u003e Writing – original draft, Visualization, Software, Resources, Supervision, Formal analysis, \u003cstrong\u003eA.A.:\u0026nbsp;\u003c/strong\u003eWriting – original draft, Investigation, Data curation, Conceptualization.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to present our sincere thanks to all the nurses who participated in our research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOzcan S. 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Dokuz Eyl\u0026uuml;l \u0026Uuml;niversitesi Hemşirelik Fak\u0026uuml;ltesi Elektronik Dergisi. 2022; 15(3): 317-327. https://doi.org/10.46483/deuhfed.977034\u003c/li\u003e\n\u003cli\u003eYılmaz M, Bayrak Ayaş E. Sporcu \u0026ouml;ğrenciler \u0026uuml;zerine bir araştırma: vicdani zek\u0026acirc; ve empati. Kesit Akad Derg. 2021;7(29):60\u0026ndash;71. DOI : 10.29228/kesit.52638\u003c/li\u003e\n\u003cli\u003eAllahyari Bouzanjani A, Bahadori P, Nikoonam P. Nurses\u0026rsquo; empathetic behaviors: the direct and ındirect effect of their spiritual orientation. J Relig Health. 2021;60(1):134\u0026ndash;52. https://doi.org/10.1007/s10943-019-00966-9 \u003c/li\u003e\n\u003cli\u003eD\u0026uuml;ndar M, Aslan H. Association between nurses\u0026rsquo; spirituality and frequency of spiritual therapeutic care in Turkey. J Relig Health . 2022;61(3):1922\u0026ndash;35. DOI: 10.1007/s10943-022-01499-4\u003c/li\u003e\n\u003cli\u003eSis \u0026Ccedil;elik A, \u0026Ouml;zdemir F, Durmaz H, Pasinlioğlu T. Hemşirelerin maneviyat ve manevi bakımı algılama d\u0026uuml;zeyleri ve etkileyen bazı fakt\u0026ouml;rlerin belirlenmesi. J Hacettepe Univ Fac Nurs. 2014;1(3):1\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eTaylor EJ, Pari\u0026ntilde;as S, Mamier I, Atarhim MA, Angeles L, Aslan H, et al. Frequency of nurse-provided spiritual care: an international comparison. J Clin Nurs. 2023;32(3\u0026ndash;4):597\u0026ndash;609. DOI: 10.1111/jocn.16497\u003c/li\u003e\n\u003cli\u003eErcan F, K\u0026ouml;rpe G, Demir S. Bir \u0026uuml;niversite hastanesinde yataklı servislerde \u0026ccedil;alışan hemşirelerin maneviyat ve manevi bakıma ilişkin algıları. Gazi Med J. 2018;29:17\u0026ndash;22. doi:http://dx.doi.org/10.12996/gmj.2018.05 \u003c/li\u003e\n\u003cli\u003eMahasneh AM, Shammout NA, Alkhazaleh ZM, Al-Alwan AF, Abu-Eita JD. 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Shanghai Arch Psychiatry. 2013;25(6):390\u0026ndash;4. doi: 10.3969/j.issn.1002-0829.2013.06.009\u003c/li\u003e\n\u003cli\u003eBoz D, Duran C, Narin İ. . Vicdani zek\u0026acirc; iş performansı. 2019. Gece Akademi. Vicdani zek\u0026acirc; iş performansı. https://www.researchgate.net/publication/332820037 \u003c/li\u003e\n\u003cli\u003eMcEwen M. Spiritual nursing care: state of the art. Holist Nurs Pract. 2005;19(4):161\u0026ndash;8. DOI: 10.1097/00004650-200507000-00007\u003c/li\u003e\n\u003cli\u003eKarag\u0026ouml;z, S. (2022). \u0026Uuml;niversite \u0026Ouml;ğrencilerinde Dindarlık, Empatik Eğilim ve K\u0026uuml;lt\u0026uuml;rlerarası Duyarlılık İlişkisi \u0026Uuml;zerine Bir Araştırma. Değerler Eğitimi Dergisi, 20(44), 549-586. https://doi.org/10.34234/ded.1182926 \u003c/li\u003e\n\u003cli\u003eBaysoy K, Ozdemir L. Examining the relationship between nurses\u0026rsquo; spiritual care competence levels and empathy, compassion and workload levels. Ankara: Oncology Nursing Congress 20-22 October; 2022 p. 1\u0026ndash;4. Avaible at: https://www.researchgate.net/publication/363595519_Examining_the_Relationship_Between_Nurses\u0026apos;_Spiritual_Care_Competence_Levels_and_Empathy_Compassion_and_Workload_Levels \u003c/li\u003e\n\u003cli\u003eYildirim G, Kaya N, Altunbas N. Relationship between nurses\u0026rsquo; perceptions of conscience and perceptions of individualized nursing care: a cross-sectional study. Perspect Psychiatr Care. 2022;58(4):1564\u0026ndash;75. DOI: 10.1111/ppc.12964\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Empathy, Conscientious intelligence, Spirituality, Spiritual Care, Nurses, Türkiye","lastPublishedDoi":"10.21203/rs.3.rs-5895594/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5895594/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThis research aimed to determine the relationship between nurses' conscientious intelligence levels, empathy levels and perceptions of spiritual care.\u003c/p\u003e\u003ch2\u003eMaterial and Methods\u003c/h2\u003e \u003cp\u003eThis research is cross-sectional type. This study was conducted with 315 nurses working in a training and research hospital in the east of Turkey. \u0026lsquo;Conscientious Intelligence Scale\u0026rsquo;, \u0026lsquo;Empathy Quotient Scale\u0026rsquo; and \u0026lsquo;Spirituality and Spiritual Care Rating Scale\u0026rsquo; are data collection tools. The descriptive analyses of the data obtained were analyzed with Statistical Package for Social Sciences 25.0 program and Analysis of Moment Structures 26.0 program.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAs a result of structural equation modelling, nurses\u0026rsquo; conscientious intelligence levels had a positive and significant effect on their empathy levels (β\u003csub\u003e1\u003c/sub\u003e: 0.169, p\u0026thinsp;=\u0026thinsp;0.005), nurses\u0026rsquo; empathy levels had a positive and significant effect on their perceptions of spirituality and spiritual care (β\u003csub\u003e1\u003c/sub\u003e: 0.304, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and nurses' conscientious intelligence levels had a positive and significant effect on their perceptions of spirituality and spiritual care (β\u003csub\u003e1\u003c/sub\u003e:0.311, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In addition, empathy mediated the relationship between conscientious intelligence and perception of spirituality and spiritual care (Two Tailed Significance value is 0.02 and below the 95% confidence interval).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAs a result, it was determined that there was a significant relationship between nurses' levels of conscientious intelligence and their perceptions of empathy and spiritual care, and empathy mediated the relationship between conscientious intelligence and perception of spiritual care. In this context, it is thought that the development of empathy skills can play an important role in strengthening nurse-patient relationships and increasing patient satisfaction and can lead to concrete improvements in professional practices by integrating into nursing practices. For this, it is recommended that empathy-based intervention strategies should be integrated into nursing education curricula.\u003c/p\u003e","manuscriptTitle":"The mediating role of empathy in relationships between conscientious intelligence and perceptions of spiritual care among Turkish nurses; A structural equation modelling","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-03 14:03:13","doi":"10.21203/rs.3.rs-5895594/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-30T03:53:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-29T21:43:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"218744943048033848536476248874270761250","date":"2025-04-22T10:22:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153450152496600111953270715774051020297","date":"2025-04-14T16:27:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303612973547458616486151219729251696595","date":"2025-04-12T05:10:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-02T16:23:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"53953956017662326351839897603945184319","date":"2025-04-02T15:45:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-02T08:28:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-02T02:15:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-03-25T08:51:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5a68f0bc-e37e-467f-8583-dcb9a8adcb82","owner":[],"postedDate":"April 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:00:41+00:00","versionOfRecord":{"articleIdentity":"rs-5895594","link":"https://doi.org/10.1186/s12912-025-03468-0","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-07-03 15:57:12","publishedOnDateReadable":"July 3rd, 2025"},"versionCreatedAt":"2025-04-03 14:03:13","video":"","vorDoi":"10.1186/s12912-025-03468-0","vorDoiUrl":"https://doi.org/10.1186/s12912-025-03468-0","workflowStages":[]},"version":"v1","identity":"rs-5895594","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5895594","identity":"rs-5895594","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}