Relationship between Nurses’ Clinical Competency and the Observance of Patients’ Human Dignity in the Intensive Care Units

Relationship between Nurses’ Clinical Competency and the Observance of Patients’ Human Dignity in the Intensive Care Units | 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 Relationship between Nurses’ Clinical Competency and the Observance of Patients’ Human Dignity in the Intensive Care Units Mahsa Pourbayramian, Masoumeh Aghamohammadi, Mehdi Ajri-khameslou, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7962142/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Nurses, as the largest group of healthcare providers, especially in intensive care units, play a vital role in providing quality services and promoting health. It seems that providing high-quality and ethical care requires nurses to possess the necessary clinical competency. This study was designed to determine the relationship between nurses' clinical competency and the human dignity of patients in intensive care units. Methodology: This descriptive-correlational study was conducted in 2024 in intensive care units in Ardabil, a large city in northwest Iran. 196 nurses working in intensive care units were included using a census sampling method. Data collection tools included questionnaires on nurses' socio-demographic information, nurses' clinical competency, and patients' human dignity. Data were analyzed using SPSS software version 26 with descriptive statistics (frequency, mean, standard deviation) and inferential statistics (t-test, ANOVA, Pearson correlation coefficient). Results According to the results, the mean score for nurses’ clinical competency was (75.67 ± 12.69), which indicated an excellent status of clinical competency. However, the highest frequency of skills application (79.6%) was reported at the “occasionally” level. The mean score for the observance of dignity was (4.04 ± 0.44) and was at an excellent level. Among the domains, “Privacy” achieved the highest score, while “Autonomy” received the lowest score. A positive and statistically significant relationship was observed between the domains of nurses’ clinical competency and the domains of patients’ human dignity observance (P < 0.05). Conclusion The mean scores for nurses' clinical competency and respecting patients' human dignity are at high and excellent levels. Furthermore, a strong positive and significant correlation exists between clinical competency and human dignity. These findings indicate that nurses with higher clinical competency show a greater tendency and ability to preserve the human dignity of patients. The study results can serve as a basis for reviewing educational programs, continuous professional development for nurses, and formulating organizational policies to strengthen both clinical competency and respect for human dignity. Clinical competency Human dignity Intensive care unit Nurse Introduction Human dignity, as an inherent and absolute value for every individual, regardless of social status or personal superiority, has always been at the center of human societies’ attention [ 1 ]. This fundamental concept emphasizes the necessity of respecting human beings as valuable, self-determining entities endowed with fundamental rights, and not merely considering them as tools to achieve other goals [ 2 ]. In healthcare, respecting the human dignity of patients is a cornerstone of medical care [ 1 ]. The World Health Organization also emphasizes the necessity of respecting patients’ dignity, rights, and values in all care provided [ 3 ]. Failure to observe patient dignity can lead to psychological harm, reduced quality of life, and a violation of patient rights, in addition to having adverse consequences on the length of hospital stay and treatment costs [ 4 ]. Nurses, as the largest group of healthcare providers and the primary personnel responsible for patient care, play an indispensable role in enhancing the quality of medical care and community health [ 5 , 6 ]. According to the World Health Organization statistics, nurses constitute more than half of the healthcare system workforce [ 3 ], and in many developed countries, the majority of healthcare services are their responsibility. This profession is considered unique due to its care-oriented nature, which is an integral part of treatment [ 7 ]. To improve the performance of nurses and to provide high-quality care consistent with ethical principles, the presence of skilled nurses with high clinical competency is essential [ 8 ]. Clinical competency is a holistic set including knowledge, skills, attitudes, and professional judgment that nurses need to perform effective and safe interventions, adapt to new technologies, and fulfill their roles [ 5 , 9 ]. These abilities, which guarantee the safety and quality of care provided to patients, directly impact clinical outcomes and patient satisfaction [ 5 , 10 ]. A nurse with sufficient clinical competency not only possesses the necessary technical knowledge and practical skills but also utilizes emotional intelligence and strong communication skills to understand and respond to the deep human needs of patients [ 5 , 8 , 11 ]. Intensive care units, due to their complex and vital nature, are considered sensitive environments for critically ill patients. In these units, patients' human dignity can be challenged for various reasons, such as communication limitations, strong dependence on caregivers, loss of autonomy, and reduced orientation [ 12 , 13 ]. In the high-stress and invasive environments of intensive care units, where patients often grapple with pain, delirium, and disability, maintaining their dignity becomes particularly important [ 14 ]. Nurses in these environments face multiple challenges, including high workload, a dynamic and stressful environment, and continuous exposure to ethical issues, all of which can affect their ability to provide comprehensive and dignity-based care [ 9 , 10 , 15 ]. While nurses have a professional responsibility to promote and uphold patients' dignity [ 16 ], the correct understanding and application of communication and empathy-driven skills, coupled with respect, can help patients endure the difficult conditions of illness and vulnerability with greater ease [ 17 ]. Given the increasing importance of enhancing the quality of clinical care and the central role of nurses’ clinical competency in observing patients’ human dignity, especially in Intensive Care Units, conducting studies in this area seems essential. Based on this premise, the present study was conducted to determine the relationship between nurses’ clinical competency and the observance of patients’ human dignity in the Intensive Care Units. Materials and methods Study design and Participants This descriptive-correlational study was conducted from June to September 2024 at educational and medical centers in Ardabil, a large city in northwest Iran. Participants The statistical population of this study included nurses working in Intensive Care Units. The census sampling method was utilized for data collection. The statistical population comprised 226 individuals, of whom 196 were finally included in the study. Inclusion and Exclusion Criteria Inclusion criteria for nurses included a minimum of six months of work experience in Intensive Care Units, a minimum of a Bachelor's degree in Nursing, and providing written informed consent to participate in the study. Incomplete completion of the questionnaire and the voluntary desire to withdraw from the study at any point were considered exclusion criteria. Data Collection Instruments The data collection tool was a three-part questionnaire: The first questionnaire included nurses’ demographic information such as (age, gender, marital status, having a child, education level, employment status, name of the hospital working at, nurse-to-bed ratio, total work experience, work experience in the intensive care unit, shift status, average number of shifts in the last three months, having a clinical competency certificate, and having a certificate in clinical ethics workshop. The second part was the Clinical Competency Questionnaire developed by Meretoja (2003), based on Benner’s theory. It evaluates 73 nursing skills across seven different domains: “Helping Roles and Functions” (7 skills), “Teaching-Coaching” (16 skills), “Diagnostic and Monitoring” (7 skills), “Managing Rapidly Changing Situations” (8 skills), “Administering and Monitoring Therapeutic Interventions” (10 skills), “Ensuring Quality of Care and Organizational Work” (6 skills), and “Working Role” (19 skills) [ 18 , 19 ]. The acceptable score range for each skill in the self-assessment section is a minimum of 0 to a maximum of 100. Based on the score breakdown, nurses’ clinical competency is classified into four levels: Poor (0–25), Moderate (26–50), Good (51–75), and Excellent (76–100). Furthermore, the extent of use and frequency of each skill is measured using a four-point Likert scale, where a score of zero means the skill is not used, a score of one means the skill is rarely used, a score of two means the skill is occasionally used, and a score of three means the skill is frequently used. The total frequency score is calculated as a percentage. This questionnaire was previously translated and validated by Bahreini et al. (2011), with a Cronbach’s alpha coefficient calculated between 0.70 and 0.85 [ 20 ]. Since the internal consistency of the domains was reported between 0.79 and 0.91 in the studies by Meretoja and colleagues, this indicates the high reliability of the instrument. In the current study, the reliability of the instrument was recalculated, yielding a Cronbach’s alpha of 0.97, which is acceptable. The third part was the Torabizadeh et al Human Dignity Observance Questionnaire, consisting of 33 items across four domains: “Privacy,” “Communication,” “Respect,” and “Autonomy.” Items 1–6 measure Privacy, 7–12 measure Autonomy, 13–24 measure Respect, and 25–33 measure Communication. This questionnaire can assess both the extent of dignity observance and the level of its importance. The extent of dignity observance is measured on a 5-point Likert scale ranging from “Never observed” (1 point) to “Always observed” (5 points). The level of dignity importance is also assessed on a 5-point Likert scale ranging from “Not important” (1 point) to “Very important” (5 points). The minimum and maximum possible scores are 1 and 5, respectively. The overall validity and reliability of the completed questionnaires (for nurses and patients) were calculated by the designer, yielding a Cronbach’s alpha of 0.968 [ 21 ]. In the current study, the reliability of the questionnaire was also recalculated, and a Cronbach’s alpha of 0.943 was obtained, which is acceptable. Data processing Data collected through questionnaires were entered into SPSS version 26 software and analyzed using descriptive statistics (frequency, mean, and standard deviation). In the analytical part of the statistics, a one-sample t-test, independent t-test, and one-way ANOVA were used to examine the relationship between nurses' socio-demographic characteristics and their clinical competency and patients' dignity observance. Pearson's correlation coefficient was used to examine the relationship between nurses' clinical competency and patients' dignity observance. The collected data were analyzed at a significance level of P < 0.05. Results The results showed that the mean age of nurses was (33.32 ± 6.09) years, and the mean work experience in intensive care units was (7.38 ± 4.95) years. Among the nurses, (99.4%) were female and (66.8%) were married. There was a significant relationship between Observance of patient's Dignity, Employment status (0.01) and hospital of employment (< 0.001) (Table 1 ). Table 1 Nurses' characteristics of research participants Variable Average standard deviation Clinical Competency (P-Value) Observance of patient's Dignity (P-Value) age (years) 33.32 6.09 0.959 2 0.234 2 Work experience in intensive care units (years) 7.38 4.95 0.692 2 0.620 2 Variable Number Percent gender Man 11 5.6 0.26 1 0.60 1 Female 185 94.4 Employment status Permanent 160 81.7 0.49 1 0.01 1 Temporary 36 18.3 Marital status Married 131 66.8 0.50 1 0.08 1 Single 65 33.2 having a child Yes 115 58.7 0.97 1 0.12 1 No 81 41.3 Education level bachelor 173 88.3 0.51 1 0.57 1 Master 23 11.7 Hospital of employment Imam Khomeini 120 61.2 0.35 3 < 0.001 3 Imam Reza 20 10.2 Fatemi 41 20.9 Alavi 15 7.7 1 Independent Sample T-Test, 2 Pearson Correlation Test, 3 ANOVA Based on the findings, the mean score of nurses' clinical competency was (75.67 ± 12.69), indicating an excellent level of clinical competency among the studied nurses. Among the domains of nurses’ clinical Competency, the “Diagnostic function” had the highest score (79.58 ± 12.52), and the “Work role” had the lowest score (73.14 ± 14.07). Regarding the frequency of skill utilization, the “Diagnostic Function” domain achieved the highest frequency at 95.4%, while the “Therapeutic interventions” and “Work role” domains had the lowest frequency at 79.1% (Table 2 ). Table 2 Mean and standard deviation of scores of nurses' clinical competency and frequency of using Nurse Competency Scale – competencies occasionally or very often Level of competency Frequency of using competencies (%) Competency category Mean SD Helping role 78.45 13.51 89.8 Teaching-coaching 73.19 15.58 79.1 Diagnostic functions 79.58 12.52 95.4 Managing situations 75.84 13.33 87.8 Therapeutic interventions 75.01 14.90 78.1 Ensuring quality 74.47 19.49 81.1 Work role 73.14 14.07 78.1 Overall competency 75.67 12.69 84.2 Low 0–25 0 Quite good 25–50 5 (2.6%) Good 50–75 89 (45.4%) Very good 75–100 98 (50%) Regarding patients' human dignity, the mean score for dignity observance was (4.04 ± 0.44). A more detailed analysis of the items indicated that "Privacy" with a mean of (4.22 ± 0.51) had the highest score in dignity observance, while "Autonomy" with a mean of (3.90 ± 0.57) obtained the lowest score in this area (Table 3 ). Table 3 Distribution of mean scores of nurses in respecting patient dignity Domain Mean SD Privacy 4.22 0.51 Autonomy 3.90 0.57 Respect 3.99 0.42 Communication 4.05 0.52 Total dignity score 4.04 0.44 Based on the Pearson correlation coefficient, there was a positive and statistically significant relationship between clinical competency and respecting patients' dignity (P < 0.001) (Table 4 ). Table 4 Correlation between nurses' clinical Competency and respect for patients' dignity Dimensions of respecting patient dignity Privacy Autonomy Respect Communication Total dignity Dimensions of clinical Competency of nurses Coefficient P-Value Coefficient P-Value Coefficient P-Value Coefficient P-Value Coefficient P-Value Helping role 0.235 0.001 0.358 < 0.001 0.067 0.354 0.162 0.024 0.249 < 0.001 Teaching-coaching 0.312 < 0.001 0.344 < 0.001 0.156 0.029 0.231 0.001 0.309 < 0.001 Diagnostic functions 0.288 < 0.001 0.349 < 0.001 0.212 0.003 0.209 0.003 0.310 < 0.001 Managing situations 0.156 0.029 0.247 < 0.001 0.068 0.346 0.135 0.059 0.182 0.011 Therapeutic interventions 0.178 0.013 0.216 0.002 0.026 0.715 0.100 0.161 0.158 0.027 Ensuring quality 0.100 0.163 0.137 0.055 -0.52 0.470 0.031 0.665 0.071 0.325 Work role 0.217 0.002 0.296 < 0.001 0.133 0.064 0.182 0.011 0.245 0.001 Overall competency 0.241 0.001 0.314 < 0.001 0.092 0.202 0.167 0.019 0.244 0.001 Discussion The main objective of the present study was to determine the relationship between nurses’ clinical competency and the observance of patient human dignity in the intensive care units of educational and medical centers in Ardabil in 2024. The study findings indicated that both nurses’ clinical competency and the observance of patient human dignity are at an “ Excellent ” level, and more importantly, a positive and significant relationship exists between these two variables. The excellent clinical competency observed in nurses of Ardabil intensive care units is consistent with the results of several studies, including the research of Mazlum et al. (2016), Mobasher Amini et al. (2017), Fotouhi et al. (2019), Lakanma et al. (2015), and Faraji et al. (1397) [ 8 , 10 , 22 – 24 ]. This consistency indicates the high commitment and skill of nurses in these critical units, likely stemming from the specialized nature and the need for continuous training in intensive care units. However, the difference compared to some studies, such as Salameh et al. (2019) and Zakeri et al. (2020), which reported a moderate level of competency [ 25 , 26 ], may be due to differences in assessment tools, demographic characteristics of the nurses, or working conditions and workload. The focus of the present study on intensive care unit nurses, who often benefit from greater job stability and more training opportunities, may justify the high level of competency observed. Regarding the observance of patients' human dignity, the findings indicated a favorable status, particularly in the domains of "Privacy" and "Communication," which had the highest mean scores. This result aligns with the findings of Torabizadeh (2021), Aydın et al. (2018), and Lindwall (2020), demonstrating the high importance of these aspects in the established care culture [ 21 , 27 , 28 ]. This consistency reflects the nurses' commitment to ethical and human principles in providing care. However, some studies, such as Fuseini (2022), have reported challenges in dignity observance in certain regions [ 29 ], indicating that this issue can be influenced by cultural, social, and managerial context. Furthermore, this assessment was from the nurses' perspective, and previous studies, such as Peyvakht et al. (2020), have shown that there might be differences between nurses' and patients' perceptions [ 30 ]. The most important finding of the study was the positive and significant relationship between clinical competency and human dignity observance. This relationship is logical and expected, as clinical competency not only includes technical knowledge and practical skills but also encompasses ethical dimensions, communication, and professional judgment. Nurses with higher clinical competency have a greater ability to establish empathetic communication, respect patients' privacy, and provide comprehensive and humane care. This finding is consistent with Ghalje et al.'s research (2008), which confirmed the relationship between clinical competency and patient satisfaction [ 31 ]. However, barriers such as high workload and staff shortages, mentioned in studies like Calnan (2013) and Bidabadi et al. (2017), can affect nurses' ability to fully apply their competency in respecting human dignity [ 32 , 33 ]. Additionally, the negative relationship between job stress and clinical competency (Komeili et al., 2013) indirectly emphasizes the importance of the work environment in preserving dignity [ 34 ]. Finally, while no significant relationship was found between demographic variables such as age and work experience with clinical competency (consistent with Fotouhi et al., 2019) [ 10 ], employment status and the hospital of employment did have a significant relationship with the observance of patients' human dignity. Specifically, nurses with permanent (formal) and contractual (Peymani) employment status (4.09 ± 0.42) scored higher in observing patient dignity compared to company and contract nurses (3.83 ± 0.47) who lack a permanent organizational affiliation. This indicates that job security and the work environment can influence nurses' commitment to observing dignity. This finding aligns with the results of Karimi (2019) and Rayat Dost (2019), who reported differences in dignity observance across various hospitals and departments [ 35 , 36 ]. This highlights the importance of job security and reliable organizational affiliation in adhering to human dignity. Overall, this research indicates that enhancing nurses' clinical competency is an effective step toward ensuring the observance of patients' human dignity. Investing in continuous training and improving nurses' working conditions will not only help strengthen their technical skills but also elevate the ethical and human dimensions of care, ultimately leading to an increase in the quality of healthcare and patient satisfaction. Study limitations The use of self-reported questionnaires to measure clinical competency and the observance of human dignity introduces the possibility of response bias; although efforts were made to minimize this by providing the questionnaires at the nurses' preferred time and location while ensuring confidentiality. Second, the focus of the research on critical care units limits the generalizability of the results to other clinical departments. Finally, confounding variables outside the researcher's control, such as heavy workload and environmental stressors, could have influenced the nurses' focus and performance in both the domain of clinical competency and the observance of human dignity. Strengths This study possesses several outstanding strengths. First, this research is the first quantitative study to investigate the direct relationship between nurses’ clinical competency and the observance of patients’ human dignity. The second important strength is the use of a comprehensive and specific questionnaire for measuring human dignity, which has been translated and validated in Iran. This significantly adds to the validity and accuracy of the results and distinguishes the study from many qualitative research approaches. Conclusion The present study investigated the relationship between nurses' clinical competency and the observance of patients' human dignity in the critical care units of Ardabil. The results showed that both the clinical competency of nurses and the level of patient human dignity observance are at a high level, and a positive and statistically significant relationship exists between these two variables. This finding clearly indicates that nurses with higher clinical competency demonstrate a greater ability and willingness to preserve and promote the human dignity of patients. In contrast to clinical competency, the demographic characteristics of nurses had a significant relationship with the observance of patients' human dignity, which may stem from the influence of organizational or environmental factors and requires further investigation. Finally, this study emphasizes the vital importance of continuously improving nurses' clinical competency, as this not only enhances the quality of clinical care but also directly contributes to ensuring and promoting patients' human dignity. These results can guide the formulation of educational programs and organizational policies aimed at simultaneously strengthening these two critical aspects. Declarations Acknowledgements The authors are extremely grateful to the Vice President of Research, School of Nursing and Midwifery, Ardabil University of Medical Sciences, the good cooperation of the managers of the medical training centers, and all the nurses who work in the Intensive Care Units, and all those who assisted the researchers in conducting this study. Author Contributions The first author was involved in the study design, data collection, data analysis, and drafting of the overall manuscript. The second and third authors was responsible for writing and approving the final version of the manuscript. The fourth author played a role in the meticulous review and revision of the manuscript. The fourth author, as the corresponding author, contributed to the design, data analysis, and interpretation. Funding This study received no external funding. Availability of Data and Materials The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate The Ethics Committee in Midwifery and Nursing Research approved the study at Ardabil University of Medical Sciences (ARUMS), receiving the ethical code (IR.ARUMS.REC.1403.050). Participation in the survey was voluntary, no personal data was collected, and anonymity was always maintained. All participants who received written information on the study had the opportunity to contact the investigators in case of questions at any time during the study. Informed written consent to participate was obtained from all of the participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Ebrahimi H, Torabizadeh C, Mohammadi E, Valizadeh S. 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Education and Ethics In Nursing ISSN: 2322-5300. 2019;8(1-2):38-44. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-7962142","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":545779348,"identity":"90b4c7a9-ad63-4a72-8a7b-74dd7c7d17af","order_by":0,"name":"Mahsa Pourbayramian","email":"","orcid":"","institution":"Ardabil University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mahsa","middleName":"","lastName":"Pourbayramian","suffix":""},{"id":545779349,"identity":"4b13f699-d093-4c88-81de-3c485de3d3e0","order_by":1,"name":"Masoumeh Aghamohammadi","email":"","orcid":"","institution":"Ardabil University of Medical 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Vosoghi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYBACgwNAgrFBQo6Nmf/hAyCbh49YLcb87DzMBiAtbERqYUic2c/DJgESIahFsr394cOvOywYNxzmPVb5NcdOho2B+eGjG/i09JwxNpY9I8FscJgv7bbstmSgw9iMjXPwaZmRwyYt2SbBZnCYwey25DZmoBYeNml8Wvgl0p+BtPCAtBRLbqsnRkuCmeTHNgkJyWYeM8aP2w4T1sLGA/QLY5uEAT8zW7I047bjPGzMBPzCxg4MsZ9tdfVt/IcPfvy5rdqen7354WN8WkCAmQeFwUxAOQgw/kBnjIJRMApGwShABgASv0IbI2BbRgAAAABJRU5ErkJggg==","orcid":"","institution":"Ardabil University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Nazila","middleName":"Vosoghi","lastName":"Vosoghi","suffix":""}],"badges":[],"createdAt":"2025-10-27 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09:01:11","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":100795,"visible":true,"origin":"","legend":"","description":"","filename":"c8ffc9c949ca42aa9b6515bc8f5f3b8a1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7962142/v1/e9d1516d91949f93d7271503.xml"},{"id":96704180,"identity":"83e8f12c-7798-4167-b411-011ecd084bc4","added_by":"auto","created_at":"2025-11-25 09:01:11","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110034,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7962142/v1/36f1b61fbf4c4f1c0b669617.html"},{"id":109614016,"identity":"95e0b83f-88db-494e-8e83-190204d07627","added_by":"auto","created_at":"2026-05-20 08:11:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":267557,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7962142/v1/eeb2f9db-0858-4a09-9077-cccb2d9ab5b6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relationship between Nurses’ Clinical Competency and the Observance of Patients’ Human Dignity in the Intensive Care Units","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHuman dignity, as an inherent and absolute value for every individual, regardless of social status or personal superiority, has always been at the center of human societies\u0026rsquo; attention [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This fundamental concept emphasizes the necessity of respecting human beings as valuable, self-determining entities endowed with fundamental rights, and not merely considering them as tools to achieve other goals [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In healthcare, respecting the human dignity of patients is a cornerstone of medical care [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The World Health Organization also emphasizes the necessity of respecting patients\u0026rsquo; dignity, rights, and values in all care provided [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Failure to observe patient dignity can lead to psychological harm, reduced quality of life, and a violation of patient rights, in addition to having adverse consequences on the length of hospital stay and treatment costs [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNurses, as the largest group of healthcare providers and the primary personnel responsible for patient care, play an indispensable role in enhancing the quality of medical care and community health [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. According to the World Health Organization statistics, nurses constitute more than half of the healthcare system workforce [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and in many developed countries, the majority of healthcare services are their responsibility. This profession is considered unique due to its care-oriented nature, which is an integral part of treatment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. To improve the performance of nurses and to provide high-quality care consistent with ethical principles, the presence of skilled nurses with high clinical competency is essential [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eClinical competency is a holistic set including knowledge, skills, attitudes, and professional judgment that nurses need to perform effective and safe interventions, adapt to new technologies, and fulfill their roles [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These abilities, which guarantee the safety and quality of care provided to patients, directly impact clinical outcomes and patient satisfaction [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. A nurse with sufficient clinical competency not only possesses the necessary technical knowledge and practical skills but also utilizes emotional intelligence and strong communication skills to understand and respond to the deep human needs of patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIntensive care units, due to their complex and vital nature, are considered sensitive environments for critically ill patients. In these units, patients' human dignity can be challenged for various reasons, such as communication limitations, strong dependence on caregivers, loss of autonomy, and reduced orientation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In the high-stress and invasive environments of intensive care units, where patients often grapple with pain, delirium, and disability, maintaining their dignity becomes particularly important [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Nurses in these environments face multiple challenges, including high workload, a dynamic and stressful environment, and continuous exposure to ethical issues, all of which can affect their ability to provide comprehensive and dignity-based care [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile nurses have a professional responsibility to promote and uphold patients' dignity [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], the correct understanding and application of communication and empathy-driven skills, coupled with respect, can help patients endure the difficult conditions of illness and vulnerability with greater ease [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Given the increasing importance of enhancing the quality of clinical care and the central role of nurses\u0026rsquo; clinical competency in observing patients\u0026rsquo; human dignity, especially in Intensive Care Units, conducting studies in this area seems essential. Based on this premise, the present study was conducted to determine the relationship between nurses\u0026rsquo; clinical competency and the observance of patients\u0026rsquo; human dignity in the Intensive Care Units.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and Participants\u003c/h2\u003e\u003cp\u003eThis descriptive-correlational study was conducted from June to September 2024 at educational and medical centers in Ardabil, a large city in northwest Iran.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eThe statistical population of this study included nurses working in Intensive Care Units. The census sampling method was utilized for data collection. The statistical population comprised 226 individuals, of whom 196 were finally included in the study.\u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eInclusion criteria for nurses included a minimum of six months of work experience in Intensive Care Units, a minimum of a Bachelor's degree in Nursing, and providing written informed consent to participate in the study. Incomplete completion of the questionnaire and the voluntary desire to withdraw from the study at any point were considered exclusion criteria.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eInstruments\u003c/h2\u003e\u003cp\u003eThe data collection tool was a three-part questionnaire:\u003c/p\u003e\u003cp\u003eThe first questionnaire included nurses\u0026rsquo; demographic information such as (age, gender, marital status, having a child, education level, employment status, name of the hospital working at, nurse-to-bed ratio, total work experience, work experience in the intensive care unit, shift status, average number of shifts in the last three months, having a clinical competency certificate, and having a certificate in clinical ethics workshop.\u003c/p\u003e\u003cp\u003eThe second part was the Clinical Competency Questionnaire developed by Meretoja (2003), based on Benner\u0026rsquo;s theory. It evaluates 73 nursing skills across seven different domains: \u0026ldquo;Helping Roles and Functions\u0026rdquo; (7 skills), \u0026ldquo;Teaching-Coaching\u0026rdquo; (16 skills), \u0026ldquo;Diagnostic and Monitoring\u0026rdquo; (7 skills), \u0026ldquo;Managing Rapidly Changing Situations\u0026rdquo; (8 skills), \u0026ldquo;Administering and Monitoring Therapeutic Interventions\u0026rdquo; (10 skills), \u0026ldquo;Ensuring Quality of Care and Organizational Work\u0026rdquo; (6 skills), and \u0026ldquo;Working Role\u0026rdquo; (19 skills) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The acceptable score range for each skill in the self-assessment section is a minimum of 0 to a maximum of 100. Based on the score breakdown, nurses\u0026rsquo; clinical competency is classified into four levels: Poor (0\u0026ndash;25), Moderate (26\u0026ndash;50), Good (51\u0026ndash;75), and Excellent (76\u0026ndash;100). Furthermore, the extent of use and frequency of each skill is measured using a four-point Likert scale, where a score of zero means the skill is not used, a score of one means the skill is rarely used, a score of two means the skill is occasionally used, and a score of three means the skill is frequently used. The total frequency score is calculated as a percentage. This questionnaire was previously translated and validated by Bahreini et al. (2011), with a Cronbach\u0026rsquo;s alpha coefficient calculated between 0.70 and 0.85 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Since the internal consistency of the domains was reported between 0.79 and 0.91 in the studies by Meretoja and colleagues, this indicates the high reliability of the instrument. In the current study, the reliability of the instrument was recalculated, yielding a Cronbach\u0026rsquo;s alpha of 0.97, which is acceptable.\u003c/p\u003e\u003cp\u003eThe third part was the Torabizadeh et al Human Dignity Observance Questionnaire, consisting of 33 items across four domains: \u0026ldquo;Privacy,\u0026rdquo; \u0026ldquo;Communication,\u0026rdquo; \u0026ldquo;Respect,\u0026rdquo; and \u0026ldquo;Autonomy.\u0026rdquo; Items 1\u0026ndash;6 measure Privacy, 7\u0026ndash;12 measure Autonomy, 13\u0026ndash;24 measure Respect, and 25\u0026ndash;33 measure Communication. This questionnaire can assess both the extent of dignity observance and the level of its importance. The extent of dignity observance is measured on a 5-point Likert scale ranging from \u0026ldquo;Never observed\u0026rdquo; (1 point) to \u0026ldquo;Always observed\u0026rdquo; (5 points). The level of dignity importance is also assessed on a 5-point Likert scale ranging from \u0026ldquo;Not important\u0026rdquo; (1 point) to \u0026ldquo;Very important\u0026rdquo; (5 points). The minimum and maximum possible scores are 1 and 5, respectively. The overall validity and reliability of the completed questionnaires (for nurses and patients) were calculated by the designer, yielding a Cronbach\u0026rsquo;s alpha of 0.968 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In the current study, the reliability of the questionnaire was also recalculated, and a Cronbach\u0026rsquo;s alpha of 0.943 was obtained, which is acceptable.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData processing\u003c/h2\u003e\u003cp\u003eData collected through questionnaires were entered into SPSS version 26 software and analyzed using descriptive statistics (frequency, mean, and standard deviation). In the analytical part of the statistics, a one-sample t-test, independent t-test, and one-way ANOVA were used to examine the relationship between nurses' socio-demographic characteristics and their clinical competency and patients' dignity observance. Pearson's correlation coefficient was used to examine the relationship between nurses' clinical competency and patients' dignity observance. The collected data were analyzed at a significance level of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe results showed that the mean age of nurses was (33.32\u0026thinsp;\u0026plusmn;\u0026thinsp;6.09) years, and the mean work experience in intensive care units was (7.38\u0026thinsp;\u0026plusmn;\u0026thinsp;4.95) years. Among the nurses, (99.4%) were female and (66.8%) were married. There was a significant relationship between Observance of patient's Dignity, Employment status (0.01) and hospital of employment (\u0026lt;\u0026thinsp;0.001) (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\u003eNurses' characteristics of research participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAverage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003estandard deviation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eClinical Competency\u003c/p\u003e\u003cp\u003e(P-Value)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eObservance of patient's Dignity (P-Value)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eage (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.959\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.234\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWork experience in intensive care units (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.692\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.620\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVariable\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eNumber\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ePercent\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003egender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMan\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.26\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.60\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e94.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eEmployment status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePermanent\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e81.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.49\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.01\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eTemporary\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\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=\"left\" colname=\"c3\"\u003e\u003cp\u003e131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e66.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.50\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.08\u003csup\u003e1\u003c/sup\u003e\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=\"left\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003ehaving a child\u003c/b\u003e\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=\"left\" colname=\"c3\"\u003e\u003cp\u003e115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e58.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.97\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.12\u003csup\u003e1\u003c/sup\u003e\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=\"left\" colname=\"c3\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ebachelor\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e173\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e88.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.51\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.57\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMaster\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eHospital of employment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eImam Khomeini\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e61.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.35\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eImam Reza\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFatemi\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eAlavi\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e1\u003c/sup\u003e Independent Sample T-Test, \u003csup\u003e2\u003c/sup\u003e Pearson Correlation Test, \u003csup\u003e3\u003c/sup\u003eANOVA\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBased on the findings, the mean score of nurses' clinical competency was (75.67\u0026thinsp;\u0026plusmn;\u0026thinsp;12.69), indicating an excellent level of clinical competency among the studied nurses. Among the domains of nurses\u0026rsquo; clinical Competency, the \u0026ldquo;Diagnostic function\u0026rdquo; had the highest score (79.58\u0026thinsp;\u0026plusmn;\u0026thinsp;12.52), and the \u0026ldquo;Work role\u0026rdquo; had the lowest score (73.14\u0026thinsp;\u0026plusmn;\u0026thinsp;14.07). Regarding the frequency of skill utilization, the \u0026ldquo;Diagnostic Function\u0026rdquo; domain achieved the highest frequency at 95.4%, while the \u0026ldquo;Therapeutic interventions\u0026rdquo; and \u0026ldquo;Work role\u0026rdquo; domains had the lowest frequency at 79.1% (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\u003eMean and standard deviation of scores of nurses' clinical competency and frequency of using Nurse Competency Scale \u0026ndash; competencies occasionally or very often\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eLevel of\u003c/p\u003e\u003cp\u003ecompetency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003eFrequency of using competencies (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompetency category\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eSD\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\u003eHelping role\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e13.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e89.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTeaching-coaching\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e15.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e79.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiagnostic functions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e12.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e95.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eManaging situations\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e13.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e87.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTherapeutic interventions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e14.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e78.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEnsuring quality\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e19.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e81.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWork role\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e14.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e78.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eOverall competency\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e12.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e84.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003e0\u0026ndash;25\u003c/p\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQuite good\u003c/p\u003e\u003cp\u003e25\u0026ndash;50\u003c/p\u003e\u003cp\u003e5 (2.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003cp\u003e50\u0026ndash;75\u003c/p\u003e\u003cp\u003e89 (45.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eVery good\u003c/p\u003e\u003cp\u003e75\u0026ndash;100\u003c/p\u003e\u003cp\u003e98 (50%)\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\u003eRegarding patients' human dignity, the mean score for dignity observance was (4.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44). A more detailed analysis of the items indicated that \"Privacy\" with a mean of (4.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51) had the highest score in dignity observance, while \"Autonomy\" with a mean of (3.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57) obtained the lowest score in this area (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\u003eDistribution of mean scores of nurses in respecting patient dignity\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\u003eDomain\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD\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\u003ePrivacy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAutonomy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRespect\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCommunication\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal dignity score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.44\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\u003eBased on the Pearson correlation coefficient, there was a positive and statistically significant relationship between clinical competency and respecting patients' dignity (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\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\u003eCorrelation between nurses' clinical Competency and respect for patients' dignity\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDimensions of respecting patient dignity\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePrivacy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eAutonomy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eRespect\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003eCommunication\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003eTotal dignity\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDimensions of clinical Competency of nurses\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eCoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eP-Value\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\u003eHelping role\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.235\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.354\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTeaching-coaching\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.344\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiagnostic functions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.349\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.310\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eManaging situations\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.247\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.068\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.346\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.059\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTherapeutic interventions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.715\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEnsuring quality\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.163\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.055\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.470\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.665\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.071\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.325\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWork role\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.217\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOverall competency\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.241\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.314\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.092\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.202\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe main objective of the present study was to determine the relationship between nurses\u0026rsquo; clinical competency and the observance of patient human dignity in the intensive care units of educational and medical centers in Ardabil in 2024. The study findings indicated that both nurses\u0026rsquo; clinical competency and the observance of patient human dignity are at an \u0026ldquo;\u003cb\u003eExcellent\u003c/b\u003e\u0026rdquo; level, and more importantly, a \u003cb\u003epositive and significant relationship\u003c/b\u003e exists between these two variables.\u003c/p\u003e\u003cp\u003eThe excellent clinical competency observed in nurses of Ardabil intensive care units is consistent with the results of several studies, including the research of Mazlum et al. (2016), Mobasher Amini et al. (2017), Fotouhi et al. (2019), Lakanma et al. (2015), and Faraji et al. (1397) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This consistency indicates the high commitment and skill of nurses in these critical units, likely stemming from the specialized nature and the need for continuous training in intensive care units. However, the difference compared to some studies, such as Salameh et al. (2019) and Zakeri et al. (2020), which reported a moderate level of competency [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], may be due to differences in assessment tools, demographic characteristics of the nurses, or working conditions and workload. The focus of the present study on intensive care unit nurses, who often benefit from greater job stability and more training opportunities, may justify the high level of competency observed.\u003c/p\u003e\u003cp\u003eRegarding the observance of patients' human dignity, the findings indicated a favorable status, particularly in the domains of \"Privacy\" and \"Communication,\" which had the highest mean scores. This result aligns with the findings of Torabizadeh (2021), Aydın et al. (2018), and Lindwall (2020), demonstrating the high importance of these aspects in the established care culture [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This consistency reflects the nurses' commitment to ethical and human principles in providing care. However, some studies, such as Fuseini (2022), have reported challenges in dignity observance in certain regions [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], indicating that this issue can be influenced by cultural, social, and managerial context. Furthermore, this assessment was from the nurses' perspective, and previous studies, such as Peyvakht et al. (2020), have shown that there might be differences between nurses' and patients' perceptions [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe most important finding of the study was the positive and significant relationship between clinical competency and human dignity observance. This relationship is logical and expected, as clinical competency not only includes technical knowledge and practical skills but also encompasses ethical dimensions, communication, and professional judgment. Nurses with higher clinical competency have a greater ability to establish empathetic communication, respect patients' privacy, and provide comprehensive and humane care. This finding is consistent with Ghalje et al.'s research (2008), which confirmed the relationship between clinical competency and patient satisfaction [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. However, barriers such as high workload and staff shortages, mentioned in studies like Calnan (2013) and Bidabadi et al. (2017), can affect nurses' ability to fully apply their competency in respecting human dignity [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Additionally, the negative relationship between job stress and clinical competency (Komeili et al., 2013) indirectly emphasizes the importance of the work environment in preserving dignity [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFinally, while no significant relationship was found between demographic variables such as age and work experience with clinical competency (consistent with Fotouhi et al., 2019) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], employment status and the hospital of employment did have a significant relationship with the observance of patients' human dignity. Specifically, nurses with permanent (formal) and contractual (Peymani) employment status (4.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42) scored higher in observing patient dignity compared to company and contract nurses (3.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47) who lack a permanent organizational affiliation. This indicates that job security and the work environment can influence nurses' commitment to observing dignity. This finding aligns with the results of Karimi (2019) and Rayat Dost (2019), who reported differences in dignity observance across various hospitals and departments [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This highlights the importance of job security and reliable organizational affiliation in adhering to human dignity.\u003c/p\u003e\u003cp\u003eOverall, this research indicates that enhancing nurses' clinical competency is an effective step toward ensuring the observance of patients' human dignity. Investing in continuous training and improving nurses' working conditions will not only help strengthen their technical skills but also elevate the ethical and human dimensions of care, ultimately leading to an increase in the quality of healthcare and patient satisfaction.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eStudy limitations\u003c/h2\u003e\u003cp\u003eThe use of self-reported questionnaires to measure clinical competency and the observance of human dignity introduces the possibility of response bias; although efforts were made to minimize this by providing the questionnaires at the nurses' preferred time and location while ensuring confidentiality. Second, the focus of the research on critical care units limits the generalizability of the results to other clinical departments. Finally, confounding variables outside the researcher's control, such as heavy workload and environmental stressors, could have influenced the nurses' focus and performance in both the domain of clinical competency and the observance of human dignity.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eStrengths\u003c/h2\u003e\u003cp\u003eThis study possesses several outstanding strengths. First, this research is the first quantitative study to investigate the direct relationship between nurses\u0026rsquo; clinical competency and the observance of patients\u0026rsquo; human dignity. The second important strength is the use of a comprehensive and specific questionnaire for measuring human dignity, which has been translated and validated in Iran. This significantly adds to the validity and accuracy of the results and distinguishes the study from many qualitative research approaches.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe present study investigated the relationship between nurses' clinical competency and the observance of patients' human dignity in the critical care units of Ardabil. The results showed that both the clinical competency of nurses and the level of patient human dignity observance are at a high level, and a positive and statistically significant relationship exists between these two variables. This finding clearly indicates that nurses with higher clinical competency demonstrate a greater ability and willingness to preserve and promote the human dignity of patients.\u003c/p\u003e\u003cp\u003eIn contrast to clinical competency, the demographic characteristics of nurses had a significant relationship with the observance of patients' human dignity, which may stem from the influence of organizational or environmental factors and requires further investigation. Finally, this study emphasizes the vital importance of continuously improving nurses' clinical competency, as this not only enhances the quality of clinical care but also directly contributes to ensuring and promoting patients' human dignity. These results can guide the formulation of educational programs and organizational policies aimed at simultaneously strengthening these two critical aspects.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are extremely grateful to the Vice President of Research, School of Nursing and Midwifery, Ardabil University of Medical Sciences, the good cooperation of the managers of the medical training centers, and all the nurses who work in the Intensive Care Units, and all those who assisted the researchers in conducting this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe first author was involved in the study design, data collection, data analysis, and drafting of the overall manuscript. The second and third authors was responsible for writing and approving the final version of the manuscript. The fourth author played a role in the meticulous review and revision of the manuscript. The fourth author, as the corresponding author, contributed to the design, data analysis, and interpretation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee in Midwifery and Nursing Research approved the study\u0026nbsp;at Ardabil University of Medical Sciences (ARUMS), receiving the ethical code (IR.ARUMS.REC.1403.050). Participation in the survey was voluntary, no personal data was collected, and anonymity was always maintained. All participants who received written information on the study had the opportunity to contact the investigators in case of questions at any time during the study. Informed written consent to participate was obtained from all of the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEbrahimi H, Torabizadeh C, Mohammadi E, Valizadeh S. Patients\u0026apos; perception of dignity in Iranian healthcare settings: a qualitative content analysis. Journal of medical ethics. 2012;38(12):723-8.\u003c/li\u003e\n\u003cli\u003eBostrom N. Dignity and enhancement. 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Pharmacophore. 2017;8(6s):e1173434.\u003c/li\u003e\n\u003cli\u003eLakanmaa R-L, Suominen T, Ritmala-Castr\u0026eacute;n M, Vahlberg T, Leino-Kilpi H. Basic Competency of intensive care unit nurses: cross‐sectional survey study. BioMed research international. 2015;2015(1):536724.\u003c/li\u003e\n\u003cli\u003eSalameh B, Amarneh DBS, Abdallah J, Ayed A, Hammad BM. Evaluation of clinical Competency and job satisfaction and their related factors among emergency nurses in Palestinian hospitals. SAGE Open Nursing. 2023;9:23779608231208581.\u003c/li\u003e\n\u003cli\u003eZakeri MA, Bazmandegan G, Ganjeh H, Zakeri M, Mollaahmadi S, Anbariyan A, et al. Is nurses\u0026rsquo; clinical Competency associated with their compassion satisfaction, burnout and secondary traumatic stress? A cross‐sectional study. Nursing Open. 2021;8(1):354-63.\u003c/li\u003e\n\u003cli\u003eEr RA, Incedere A, \u0026Ouml;zt\u0026uuml;rk S. Respectful care of human dignity: how is it perceived by patients and nurses? Journal of medical ethics. 2018;44(10):675-80.\u003c/li\u003e\n\u003cli\u003eLindwall L, Lohne V. Human dignity research in clinical practice\u0026ndash;a systematic literature review. Scandinavian Journal of Caring Sciences. 2021;35(4):1038-49.\u003c/li\u003e\n\u003cli\u003eFuseini AG, Ley L, Rawson H, Redley B, Kerr D. A systematic review of patient‐reported dignity and dignified care during acute hospital admission. Journal of Advanced Nursing. 2022;78(11):3540-58.\u003c/li\u003e\n\u003cli\u003ePeyvakht A, Sanagoo A, Behnampour N, Roshandel G, Jouybari L. Perspectives of nurses and the elderly hospitalized patients eegard respecting the human dignity of elderly patients in educational and Medical Centers of Golestan University of Medical Sciences in 2019. Journal of Nursing Education. 2020;9(3):79-87.\u003c/li\u003e\n\u003cli\u003eGhalje M, Ghaljae F. Association between clinical competency and patient\u0026apos;s satisfaction from nursing care. Advances in Nursing \u0026amp; Midwifery. 2009;18(63):12-9.\u003c/li\u003e\n\u003cli\u003eCalnan M, Tadd W, Calnan S, Hillman A, Read S, Bayer A. \u0026lsquo;I often worry about the older person being in that system\u0026rsquo;: exploring the key influences on the provision of dignified care for older people in acute hospitals. Ageing \u0026amp; Society. 2013;33(3):465-85.\u003c/li\u003e\n\u003cli\u003eBidabadi FS, Yazdannik A, Zargham-Boroujeni A. Patient\u0026rsquo;s dignity in intensive care unit: A critical ethnography. Nursing ethics. 2019;26(3):738-52.\u003c/li\u003e\n\u003cli\u003eKOMEILI SH, Etemadi A, Boustani H, Bahreini M, Hakim A. THE RELATIONSHIP BETWEEN NURSES\u0026apos;CLINICAL COMPETENCY AND JOB STRESS IN AHVAZ UNIVERSITY HOSPITAL, 2013. 2015.\u003c/li\u003e\n\u003cli\u003eKarimi H, Ajorpaz NM, Aghajani M. Older adults\u0026apos; and nurses perception of dignity in the setting of Iranian hospitals: A cross-sectional study. Central European Journal of Nursing and Midwifery. 2019;10(4):1134-42.\u003c/li\u003e\n\u003cli\u003eRayat Dost E, Kalani N, Zare M. Status of Respect for Dignity of Hospitalized Patients from Nurses\u0026acirc; Perspectives: A Descriptive, Cross-Sectional Study in 2018. Education and Ethics In Nursing ISSN: 2322-5300. 2019;8(1-2):38-44.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Clinical competency, Human dignity, Intensive care unit, Nurse","lastPublishedDoi":"10.21203/rs.3.rs-7962142/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7962142/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eNurses, as the largest group of healthcare providers, especially in intensive care units, play a vital role in providing quality services and promoting health. It seems that providing high-quality and ethical care requires nurses to possess the necessary clinical competency. This study was designed to determine the relationship between nurses' clinical competency and the human dignity of patients in intensive care units.\u003c/p\u003e\u003ch2\u003eMethodology:\u003c/h2\u003e\u003cp\u003eThis descriptive-correlational study was conducted in 2024 in intensive care units in Ardabil, a large city in northwest Iran. 196 nurses working in intensive care units were included using a census sampling method. Data collection tools included questionnaires on nurses' socio-demographic information, nurses' clinical competency, and patients' human dignity. Data were analyzed using SPSS software version 26 with descriptive statistics (frequency, mean, standard deviation) and inferential statistics (t-test, ANOVA, Pearson correlation coefficient).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAccording to the results, the mean score for nurses\u0026rsquo; clinical competency was (75.67\u0026thinsp;\u0026plusmn;\u0026thinsp;12.69), which indicated an excellent status of clinical competency. However, the highest frequency of skills application (79.6%) was reported at the \u0026ldquo;occasionally\u0026rdquo; level. The mean score for the observance of dignity was (4.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44) and was at an excellent level. Among the domains, \u0026ldquo;Privacy\u0026rdquo; achieved the highest score, while \u0026ldquo;Autonomy\u0026rdquo; received the lowest score. A positive and statistically significant relationship was observed between the domains of nurses\u0026rsquo; clinical competency and the domains of patients\u0026rsquo; human dignity observance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe mean scores for nurses' clinical competency and respecting patients' human dignity are at high and excellent levels. Furthermore, a strong positive and significant correlation exists between clinical competency and human dignity. These findings indicate that nurses with higher clinical competency show a greater tendency and ability to preserve the human dignity of patients. The study results can serve as a basis for reviewing educational programs, continuous professional development for nurses, and formulating organizational policies to strengthen both clinical competency and respect for human dignity.\u003c/p\u003e","manuscriptTitle":"Relationship between Nurses’ Clinical Competency and the Observance of Patients’ Human Dignity in the Intensive Care Units","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-25 09:01:06","doi":"10.21203/rs.3.rs-7962142/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"061d0087-badd-4e3b-98da-88a37ae011f4","owner":[],"postedDate":"November 25th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Withdrawn","date":"2026-05-20T07:58:30+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-20T08:11:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-25 09:01:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7962142","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7962142","identity":"rs-7962142","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}