Relationship between Moral Intelligence, Teamwork, and Missed Nursing Cares in Hospital Nurses: A Cross-Sectional Study

Relationship between Moral Intelligence, Teamwork, and Missed Nursing Cares in Hospital Nurses: A Cross-Sectional Study | 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 Moral Intelligence, Teamwork, and Missed Nursing Cares in Hospital Nurses: A Cross-Sectional Study Alireza Gholampour-Nooran, Fatemeh Bezaatpour, Bita Hashemi, Mehdi Ajri-Khameslou This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7329125/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Ensuring quality and safety in care remains a top priority for the healthcare. Insufficient nurse staffing and missed care are linked to lower care standards and the occurrence of adverse events. This study aimed to illustrate the relationship between moral intelligence, teamwork, and missed nursing care, and how moral intelligence and teamwork affect quality of care and adverse hospital events. Methods This correlational study included 300 nurses in teaching hospitals with a stratified random sampling method. The participants completed Lennick and Kiel’s moral intelligence questionnaire and the Teamwork and MISSCARE questionnaire. The JBI guideline and STROBE checklist were followed for reporting in the study. Descriptive statistics, independent T-test, one-way ANOVA, and Multivariable regression models were used to estimate associations. Results The mean score (± SD) of moral intelligence, teamwork, and missed nursing care was 74.41 (± 10.61), 3.37 (± 0.6), and 37.3 (± 11.83). This showed an acceptable level of moral intelligence, moderate teamwork, and a low level of missed care in nurses. Nurses with more working years had fewer missed care, and the male nurses had more missed care (41.16 ± 12.15) than the female nurses (36.36 ± 12.15). The regression analysis results show that gender, working years, moral intelligence, and teamwork significantly predict missed nursing care. Conclusions This study showed an acceptable level of moral intelligence, moderate teamwork, and a low level of missed care in nurses. Gender, working years, moral intelligence, and teamwork significantly predict missed nursing care. Implications for Nursing Management: Enhancing moral intelligence and ensuring sufficient resources are recommended to reduce missed nursing care, prevent adverse events, and improve the quality of care. Moral Intelligence Teamwork Missed Nursing Care Nurse What is already known Missed nursing care is crucial for measuring nursing quality and patient safety. Quality and safety in care remains a top priority for the healthcare The literature has not yet identified predictors of missed nursing care. What this paper adds The findings of this study show that gender, years of work experience, moral intelligence, and teamwork significantly predict missed nursing care. Improvement of moral intelligence and teamwork can lead to a reduction in missed nursing care. Background In healthcare, every professional is responsible for improving patients' health and well-being while working to prevent complications that arise from illnesses [ 1 ]. In the healthcare system, nurses have an important role in caring with patients [ 2 ]. Nursing can be seen as a model that includes physical, emotional, cognitive, and organizational work. These different types of work are often hidden and unnoticed. This framework emphasizes the supportive role of patient safety [ 3 ]. Nurses' caring involves visible and invisible caring [ 4 ]. A study conducted in Australia revealed that nurses dedicated approximately 37% of their time to patient care. [ 5 ]. Considering the important role of nurses in caring for patients, nurses experience a moral climate. The ethical climate in the care system significantly impacts the safety of patients and the results of care and treatment. Because of the importance of this issue, the ethical climate in nursing was defined as a way to understand how to handle ethical issues in their specific work environment [ 6 – 8 ]. Victor and Cullen first introduced the concept of "ethical climate" in 1988. [ 9 ]. However, knowing and applying ethical principles is directly related to human intelligence [ 10 ]. Intelligence can be described as a broad mental capacity for reasoning, problem-solving, and learning [ 11 , 12 ]. Moral intelligence was introduced as a concept in 2005 by Doug Lennick and Fred Kiel: "Moral intelligence is the capacity to understand right from wrong, to have strong ethical convictions and to act on them to behave in the right and honorable way." [ 13 ]. A cross-sectional study in Iran (2023) found that nurses with elevated moral intelligence demonstrate a more substantial commitment to patient safety protocols, and the moral intelligence of nurses helps them to think carefully and make more measured decisions before each action [ 14 ]. Also, paying more attention to moral intelligence as a mediator to properly manage personality traits that are effective in reducing nurses' burnout can lead to improving the quality of nursing care [ 15 ]. On the other hand, factors such as moral values, individual abilities, skills, family history, work experience, social status, psychological factors like perceptions, roles, attitudes, personality, motivation, work environment, job satisfaction, and organizational behaviors and decisions of nurses all have an effect [ 10 , 16 ]. Ghezeljeh et al. (2021) found that teamwork is an effective solution for enhancing the quality of care [ 17 ], and effective teamwork is necessary for conducting patient safety [ 18 ]. Teamwork is “a group of employees who do a job assigned by the leader” [ 19 ]. Emich (2018) defined nursing teamwork as “an interprofessional process where nurses and other healthcare members work together to solve patient care issues, emphasizing respect and shared knowledge” [ 20 ]. It has dimensions such as leadership, a shared understanding of roles, and mutual respect among team members [ 21 ]. Hassan et al. (2024) conducted a quasi-experimental pretest-posttest study on newly graduated nurses. In this study, educational intervention was done using the TeamSTEPPS training program. The results demonstrated improved perceptions of teamwork and patient safety culture after TeamSTEPPS training, with significant improvements [ 22 ]. Also, better teamwork causes higher patient satisfaction and better care continuity [ 23 ]. Missed nursing care is an important concept to understand and measure the quality of nursing and patient safety [ 24 ]. It encompasses any care component that is either omitted or delayed, partially or entirely. [ 25 ]. Factors such as human resources, material, communication, adequacy of nursing staff, satisfaction with income, and working in a medical unit are important reasons nurses identify for missed care [ 26 , 27 ]. A systematic review conducted to investigate missed nursing care in low-income and middle-income countries showed that the prevalence of missed nursing care ranges from 15.2–86%[ 28 ] based on studies of overall average care. Missed care in Saudi Arabia was 1.37 [ 29 ], United States 1.71[ 30 ], Australia 2.02 [ 31 ], South Korea 1.40 [ 30 ], Egypt 2.26 [ 32 ], and Jordan was 2.78 [ 33 ]. The average in Iranian hospitals was 2.57, and 72.1% of nurses reported missing at least one nursing care item in their last working shift [ 26 ]. A cross-sectional study conducted by White et al. (2024) found that missed nursing care is associated with inadequate time or resources and it can lead to burnout and job dissatisfaction in the nurses [ 34 ]. Low patient safety leads to approximately 134 million adverse events, leading to 2.6 million deaths in low- and middle-income countries [ 35 ]. Janatolmakan et al. (2022), in a qualitative descriptive study, concluded that the organization-related consequences of missed nursing care are increased costs, reduced organizational credibility, absenteeism, intention to leave, and subsequent turnover. So they concluded that the healthcare centers need to increase nurses’ job satisfaction and encourage them to report this type of care [ 36 ]. Evidence indicates that missed care is prevalent in many medical centers, posing a significant risk to patient safety. Additionally, missed care impacts nurses' performance and job satisfaction. This raises an important question: how can we reduce the frequency of missed care among nurses? This study aims to explore the relationship between moral intelligence, teamwork, and the factors contributing to missed nursing care, with the goal of improving job satisfaction for nurses and enhancing patient safety to ultimately improve treatment outcomes. Research Methodology This cross-sectional, descriptive, and correlational study was carried out from November to February 2023 and included 300 nurses who fulfilled the sampling criteria with a stratified random sampling method. The sample size was determined to be 330 nurses using this formula (z = 1.96, p = 0.5, q = 0.5, 10% dropout rate). $$\:n=\:\frac{\frac{{z}^{2}pq}{{d}^{2}}}{1+\:\frac{1}{N}\:\left[\frac{{z}^{2}pq}{{d}^{2}}-1\right]}$$ Nurses who provided informed consent and had more than six months of experience working in five teaching hospitals in Ardabil city, located in Northwest Iran, were included in the study. Nurses working in delivery rooms and operating rooms who were not directly involved in patient care were excluded. A total of 330 questionnaires were distributed, and 310 responses were received, of which 300 were valid, resulting in a valid return rate of 90.9%. The data collection instruments included the demographics form, Lennick and Kiel’s moral intelligence short-form questionnaire, Kalish’s teamwork questionnaire, and Kalish’s missed nursing care questionnaire (MISSCARE). The demographic information questionnaire included age, gender, marital status, gender, working years, education, employment status, position, and Ward. The Moral Intelligence Questionnaire, designed and developed by Lennick and Kiel in 2005, consists of 20 items that assess various aspects of moral intelligence. This survey includes three subscales: honesty (with 12 questions), forgiveness, and compassion (each containing 4 questions). Participants respond using a 5-point Likert scale, where 1 means "never" and 5 means "always." The total score can range from 20 to 100, with the following categories: a score of 20–33 indicates low moral intelligence, 34–66 indicates moderate moral intelligence, and 67–100 indicates high moral intelligence [ 37 , 38 ]. In a study conducted in Iran, Majidi and et al evaluated the reliability of this questionnaire and found a Cronbach's alpha of 0.83, which indicates good reliability [ 39 ]. In our study, the Cronbach's alpha for this questionnaire was found to be 0.90, indicating excellent reliability. In this study, Cronbach's alpha was 0.9 for this questionnaire. The Kalisch teamwork questionnaire (NTS) (2010) contains 33 items divided into five subscales: trust (7 items), awareness of teamwork (9 items), mutual support (6 items), team leadership (4 items), and shared mental model (7 items). Responses are measured on a 5-point Likert scale, ranging from "never" to "always". The mean score of the items is considered the teamwork score. The minimum and maximum scores on the scale are 1 and 5, respectively; higher scores reflect better teamwork among nurses. The Cronbach's alpha for this questionnaire was also reported as 0.83, suggesting it is a reliable tool for assessing teamwork [ 40 ]. Since the original questionnaire was in English, we translated it into Persian for our study. In this study, Cronbach's alpha was 0.93. For measuring missed nursing care (MNC), the MISSCARE Survey was employed, which was developed by Kalisch and Williams (2009). In total, 24 items ask about the type and frequency of missed nursing care, using a 4-point Likert scale from "rarely = 1" to "always = 4". The total scores range from 24 to 96, where a higher score indicates a greater likelihood of missed care [ 25 ]. Khajavi et al. assessed the content and face validity of this questionnaire, finding it suitable for use. Their study reported a Cronbach's alpha of 0.91, indicating strong reliability [ 41 ]. In this study, Cronbach's alpha was obtained as 0.94 for this questionnaire. After obtaining permission for the study from each hospital's nursing department, data were collected from August to September 2022. Informed consent forms for study participation were signed before the start of the study. Anonymized blank envelopes were provided for the participants to place the completed questionnaire in the envelope, seal it, and return it. The Research Ethics Committee of Ardabil University of Medical Sciences approved this study. Informed consent was obtained from the nurses. The study is congruent with the Declaration of Helsinki regarding medical research involving human subjects. Data were analyzed using SPSS version 15, descriptive statistics (mean and standard deviation), and inferential statistics (one-sample T-test, independent T-test, one-way ANOVA, Pearson's correlation coefficients, and linear regression). The data has a normal distribution (Kolmogorov-Smirnov normality test with a p-value = 0.05). The significance level was 0.05. The JBI guidelines for observational studies and the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist ensure comprehensive and transparent reporting of our findings. Results Our sample of 300 nurses comprised 241 females (80.3%) and 59 males (19.7%). The age of the nurses was between 22 and 52 years old (mean: 33.59 ± 6.8). About 80% of the nurses were female, 40% of the nurses had worked fewer than 7 years, and the mean (± SD) of total working years was 9.55 (± 6.1). The descriptive characteristics of the nurses are represented in Table 1 . Table 1 Demographic Characteristics of Nurses (N = 300 surveys) Variables Categories Frequency Percent Age 22–32 138 46 32–42 132 44 42–52 30 10 Gender Male 59 19.7 Female 241 80.3 Work Experience (year) 0.5-7 117 39 7–14 116 38.7 14–21 57 19 21–28 10 3.3 Education Bachelor's Degree 287 95.7 Master's Degree 13 4.3 Position Supervisor 4 1.3 Head Nurse 8 2.7 Staff Nurse 288 96 Ward Emergency 51 17 General 25 8.3 Obstetrics 30 10 Pediatrics 48 16 Intensive care 24 8 Medical – Surgical 122 40.7 The mean score (± SD) of moral intelligence was 74.41 (± 10.61), indicating an acceptable level of moral intelligence in 82.3% of nurses. The mean score (± SD) of teamwork was 3.37 (± 0.6), and the results showed that the highest mean score of teamwork was for the dimension of "Trust" (3.48 ± 0.74), and the lowest one was for the dimension of "Shared mental model" (3.26 ± 0.63), Table 2 . Table 2 Descriptive Statistics of Moral Intelligence and Teamwork Variable Subscales Number of items Mean SD Moral intelligence Honesty 12 45.58 6.58 Forgiveness 4 13.69 2.8 Compassion 4 15.13 2.5 Total score 20 74.41 10.61 Teamwork Trust 7 3.48 0.74 Teamwork awareness 9 3.35 0.67 Mutual support 6 3.32 0.64 Team leadership 4 3.47 0.79 Shared mental model 7 3.26 0.63 Total score 33 3.37 0.6 The mean (± SD) of missed nursing care was 37.3 (± 11.83). Nurses with more working years had fewer missed care (P = 0.001). The male nurses had more missed care (41.16 ± 12.15) than the female nurses (36.36 ± 12.15). The relationship between the nurses' demographic characteristics and missed care is provided in Table 3 . Table 3 Demographic characteristics of nurses participating in the research and its relationship with the Missed Nursing Care Variables Categories Mean SD P Age 22–32 39.84 12.3 0.002* 32–42 35.3 11.17 42–52 34.43 10.36 Gender Male 41.16 12.15 0.007** Female 36.36 11.58 Working years 0.5-7 40.47 12.37 0.001* 7–14 37.13 11.94 14–21 32.01 8.17 21–28 32.3 10.26 Education Bachelor's Degree 37.36 11.88 0.674 Master's Degree 36 11.17 Position Supervisor 34.25 9.97 0.077 Head Nurse 28.25 6.88 Staff Nurse 37.6 11.88 Ward Emergency 39.19 10.19 0.207 General 38.44 11.59 Obstetrics 35.93 11.68 Pediatrics 33.81 9.53 Intensive care 36 12.83 Medical – Surgical 38.25 13.00 Missed Nursing Care 37.3 11.83 * One-way ANOVA, ** Independent t-test The regression analysis results show that gender, working years, moral intelligence, and teamwork are among the factors affecting the non-implementation of nursing care. Improvements in these factors can help reduce non-compliance with care. This value shows that these four independent variables explain 15.7% of the variance in non-implementation of care. With the increase in working years, the rate of non-implementation of care decreases. Increasing moral intelligence and improving teamwork can lead to a reduction in non-compliance with care. Table 4 demonstrates the Predictors of Missed Nursing Care. Table 4 Multivariable Regression Factors Influencing Missed Nursing Care Independent variable Unstandardized Coefficients ꞵ t P 95% Cl B SE Lower Upper (Constant) 73.947 5.528 - 13.377 0.001 63.067 84.827 Gender -3.476 1.621 -0.117 -2.145 0.033 -6.666 -0.286 Working years -2.593 0.787 -0.183 -3.293 0.001 -4.143 -1.043 Moral Intelligence -0.152 0.067 -0.136 -2.255 0.025 -0.284 -0.019 Teamwork -4.224 1.168 -0.216 -3.617 0.001 -6.522 -1.926 Adj R 2 = 0.157, F = 14.941, P = 0.001 Discussion This study examines the phenomenon of missed nursing care and its relationship with moral intelligence and teamwork among hospital nurses. The majority of the nurses demonstrated high levels of moral intelligence, which aligns with previous findings. Heidari et al. (2022) conducted an assessment of moral intelligence, burnout, and the quality of nursing care in a sample of 125 nurses in Mazandaran, Iran. Their results indicated that the overall score of nurses’ moral intelligence was satisfactory [ 15 ]. Consistent results were reported by Gorzin et al. (2019) [ 42 ]. Also, Motlagh et al. (2019) conducted a cross-sectional study among 99 nurses working in the emergency department, finding comparable results [ 43 ]. The high level of moral intelligence of nurses is due to the nature of their profession. Therefore, teaching ethical intelligence to nurses and encouraging staff with higher ethical intelligence enhances their reasoning, problem-solving, and ability to cope with problems. The mean score (± SD) of Teamwork was 3.37 (± 0.6), and the highest mean score of Teamwork was for the dimension of “Trust” (3.48 ± 0.74); also, the lowest one was for the dimension of “Shared mental model” (3.26 ± 0.63). Jomaa et al. (2020) conducted a correlational study among 75 nursing staff members in rehabilitation units. They found a teamwork score of 3.36 (SD = 0.58), which was moderate. Also, Shared Mental Model had the highest mean, 3.84 (± 0.6), and Team Orientation 3.02 (0.69) had the lowest mean among the dimensions of nursing teamwork [ 44 ]. In a study conducted by Bragadóttir et al. (2023) involving 567 participants, the overall mean teamwork score was found to be 3.89 (± 0.47). Among the subthemes, the Shared Mental Model received the highest mean score of 4.20 (± 0.48), while team leadership had the lowest mean score of 3.65 (± 0.75) [ 45 ]. The different levels of teamwork among nurses depend on their definition of teamwork and their personality type. Therefore, it is suggested to carry out studies on the relationship between the personality type of nurses and the levels of physical activity and its effect on the safety of patients. The mean score (± SD) of missed nursing care was 37.3 (± 11.83), which means around 39.6% of nursing care was missed. In the study of Dirgar et al. (2024), the mean score (± SD) of missed nursing care was 30.82 (± 7.30), indicating that the nurses exhibited lower levels of missed nursing care compared to the average [ 44 ], which is consistent with our findings. Contrary to this, Kassahun et al. (2022) revealed that nearly 63% of nursing care was missed [ 27 ]. In different studies, the missed care reported by nurses is different and varied [ 46 ]. The reason for this discrepancy is the reediness of nurses, organization-related factors, and continuous training of nurses. Regression analyses showed that missed nursing care was affected by gender, and male nurses significantly had more missed care than females, and nurses with more working years had fewer missed care. Studies have reported that influencing factors on missed nursing care, such as age, work experience, and workload, significantly influence missed care. [ 47 , 48 ]. Campbell (2020) reported that female nurses reported higher levels of missed care than males [ 49 ]. This study's findings suggest that moral intelligence can predict missed nursing care. While previous research hasn't explicitly established this link, related findings have been reported. For instance, Shirazi et al. (2021) performed a concept analysis showing that higher moral intelligence supports nurses' personal and professional growth. This development promotes holistic care and boosts organizational performance, resulting in improved quality of health services. [ 50 ]. Moreover, Karabey et al. (2021) found that it is essential to determine moral intelligence levels, which directly affect nursing care, and the quality of the care provided [ 51 ]. Fouladi et al. (2021) in a study to predict Missed Nursing Care Based on Moral Sensitivity, reported that the components of moral sensitivity explain missed care. [ 52 ]. These findings indicate that moral intelligence directly affects personal accountability, conscientiousness, decision-making, and awareness, thereby decreasing the occurrence of missed nursing care. [ 53 ]. Teamwork has been found to be a predictor of missed nursing care. Our study aligns with a review conducted by Jones et al. (2015), which revealed that a significant majority (55–98%) of nursing staff reported leaving one or more tasks unfinished. Key factors in the nursing work environment—such as time constraints, resource availability, and teamwork—were identified as having moderately negative effects on the occurrence of missed nursing care. Additionally, the review indicated that nurses often experience moral distress, role conflict, and role strain as a result of missed care [ 54 ]. Kalánková et al. (2019) found that teamwork levels strongly predict adverse patient and nursing outcomes, and serve as indicators of care quality. [ 55 ]. Recent research highlights that implementing targeted strategies to enhance essential teamwork skills—such as fostering teamwork awareness, encouraging mutual support among team members, and developing strong team leadership—can significantly diminish the chances of overlooked nursing care. By cultivating these vital skills, healthcare teams can create a more cohesive and efficient working environment, ultimately leading to improved patient outcomes and a higher standard of care. [ 40 , 56 ]. Strengths and Limitations One of the most important limitations of the research is the enormous workload of nurses and the lack of time to fill out the questionnaire, which may have led to inaccurate responses. In addition to this, the mental conditions and motivation level of the nurses and their willingness and accuracy in answering the questions may affect the results. Conclusions This study showed an acceptable level of moral intelligence, moderate teamwork, and a low level of missed care in nurses. Gender, working years, moral intelligence, and teamwork significantly predict missed nursing care. Implications for Nursing Management Improvement of moral intelligence and teamwork can lead to a reduction in missed nursing care. Declarations Ethical Approval and Consent to Participate: The present study is a research project approved by the Student Research Committee of the School of Nursing and Midwifery, Ardabil University of Medical Sciences, with the ethics code IR.ARUMS.REC.1403.035. All participants in the study provided informed consent . Consent for publication: Authors have all rights to the data and full consent to publish this paper. The Helsinki Declaration, which was about the ethical standards of medical research on human subjects, was used to conduct the study. Competing interests: The authors have no relevant financial or nonfinancial interests to disclose. The authors have no competing interests to declare relevant to this article's content. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial Interest in the subject matter or materials discussed in this manuscript. The author(s) declare that they have no conflict of Interest. Consent for publication: Not Applicable Clinical trial number not applicable Funding: Not applicable Author Contribution Alireza Gholampour-Nooran was the primary principal investigator, responsible for the preparation of the manuscript, data analysis, and data gathering. Fatemeh Bezaatpour designed the work, contributed to writing the Final approval draft, and performed data gathering and analysis. Bita Hashemi contributed to management and coordination in the research activity, planning, and execution, and helped with English translation. Mehdi Ajri-Khameslou designed the overarching research goals and aims, methodology, data analysis, and preparation of the initial and final draft. Acknowledgement This article is undertaken from a research project of the Student Research Committee at Ardabil University of Medical Sciences with the code of ethics (IR.ARUMS.REC.1403.035). We are grateful to all the nurses who participated in the study. Data Availability The datasets generated and analyzed during the current study are not publicly available due to the participants' dissatisfaction with the institution. However, they are available from the corresponding author upon reasonable request. References Sim J, et al. Development of a data registry to evaluate the quality and safety of nursing practice. J Adv Nurs. 2019;75(9):1877–88. Miao Q, et al. The Role of Nursing Care in the Management of Patients with Traumatic Subarachnoid Hemorrhage. Galen Med J. 2023;12:1. Jackson J, Anderson JE, Maben J. What is nursing work? A meta-narrative review and integrated framework. Int J Nurs Stud. 2021;122:103944. Allen D. The invisible work of nurses: Hospitals, organisation and healthcare. Routledge; 2014. Westbrook JI, et al. How much time do nurses have for patients? A longitudinal study quantifying hospital nurses' patterns of task time distribution and interactions with health professionals. BMC Health Serv Res. 2011;11:1–12. Ozdoba P, et al. Hospital ethical climate and job satisfaction among nurses: A scoping review. Int J Environ Res Public Health. 2022;19(8):4554. Olson L. Ethical climate in health care organizations. Int Nurs Rev. 1995;42(3):85–90. Ebrahim Abdel Aty A, Ibrahim Mahmoud S, Ibrahim Ismail Z. Ethical Work Climate and its relation to Patients' Safety as Perceived by Staff Nurses. J Nurs Sci Benha Univ. 2024;5(2):381–96. Victor B, Cullen JB. The organizational bases of ethical work climates. Administrative science quarterly, 1988: pp. 101–125. Shirazi ZH, Sabetsarvestani R. Moral intelligence in nursing: an evolutionary concept analysis. Nursing Practice Today; 2021. Gottfredson LS. Intelligence: is it the epidemiologists' elusive fundamental cause of social class inequalities in health? J Personal Soc Psychol. 2004;86(1):174. Schmidt FL, Hunter J. General mental ability in the world of work: occupational attainment and job performance. J Personal Soc Psychol. 2004;86(1):162. D FKP, Lennick D. Moral Intelligence: Enhancing Business Performance and Leadership Success. Pearson Education; 2005. Ranjbar M, et al. Investigating the Relationship between Moral Intelligence and Attitude towards Patient Safety in Nurses Working at Shahid Sadoughi Teaching Hospital in Yazd in 2023. Quarterly Journal of Management Strategies in Health System; 2024. Heidari T, et al. Association between moral intelligence, burnout and quality of nursing care. London, England: SAGE Publications Sage UK; 2022. pp. 334–45. Widayati CC et al. The Effect of Emotional Intelligence, Teamwork, Organizational Culture and Empathy on Employee Performance . in 4th Social and Humanities Research Symposium (SoRes 2021) . 2022. Atlantis Press. Ghezeljeh TN, Gharasoflo S, Haghani S. The relationship between missed nursing care and teamwork in emergency nurses: a predictive correlational study. Nurs Pract Today. 2021;8(2):103–12. Nobahar M, Ameri M, Goli S. The relationship between teamwork, moral sensitivity, and missed nursing care in intensive care unit nurses. BMC Nurs. 2023;22(1):241. Sinambela LP. Manajemen Sumber Daya Manusia: Membangun tim kerja yang solid untuk meningkatkan kinerja. Bumi Aksara; 2021. Emich C. Conceptualizing collaboration in nursing . in Nursing forum . Wiley Online Library; 2018. Ryan S. Promoting effective teamwork in the healthcare setting. Nurs standard, 2017. 31(30). Hassan AE, et al. Evaluating the Effect of TeamSTEPPS on Teamwork Perceptions and Patient Safety Culture among Newly Graduated Nurses. BMC Nurs. 2024;23(1):170. Dighrir mohamadhassanA. The Collaborative Pulse of Healthcare: a critical analysis of Nursing’s Role in a Holistic Approach to Patient Care Across Medical Specialties. J Ecohumanism. 2024;3(7):2889–97. Chapman R, et al. Impact of teamwork on missed care in four Australian hospitals. J Clin Nurs. 2017;26(1–2):170–81. Kalisch BJ, Williams RA. Development and psychometric testing of a tool to measure missed nursing care. JONA: J Nurs Adm. 2009;39(5):211–9. Chegini Z, et al. Missed nursing care and related factors in Iranian hospitals: A cross-sectional survey. J Nurs Adm Manag. 2020;28(8):2205–15. Kassahun CW, et al. Missed nursing care and associated factors among nurses at University of Gondar Comprehensive Specialized Hospital, Ethiopia, 2022. Sci Rep. 2024;14(1):25571. Imam A, et al. Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review. Hum Resour Health. 2023;21(1):1–21. Al Muharraq EH et al. An Overview of Missed Nursing Care and Its Predictors in Saudi Arabia: A Cross-Sectional Study. Nursing Research and Practice, 2022. 2022. Kalisch BJ, et al. Missed nursing care, level of staffing, and job satisfaction. J Nurs Adm. 2013;43(5):274–9. Orique SB, Patty CM, Woods E. Missed nursing care and unit-level nurse workload in the acute and post-acute settings. J Nurs Care Qual. 2016;31(1):84–9. Hammad M, Guirguis W, Mosallam R. Missed nursing care, non-nursing tasks, staffing adequacy, and job satisfaction among nurses in a teaching hospital in Egypt. J Egypt Public Health Assoc. 2021;96(1):1–9. Saqer TJ, AbuAlRub RF. Missed nursing care and its relationship with confidence in delegation among hospital nurses. J Clin Nurs. 2018;27(13–14):2887–95. White EM, Aiken LH, McHugh MD. Registered Nurse Burnout, Job Dissatisfaction, and Missed Care in Nursing Homes. J Am Geriatr Soc. 2019;67(10):2065–71. Dhingra-Kumar N, Brusaferro S, Arnoldo L. Patient safety in the world. textbook of patient safety and clinical risk management, 2021: pp. 93–98. Janatolmakan M, Khatony A. Explaining the consequences of missed nursing care from the perspective of nurses: a qualitative descriptive study in Iran. BMC Nurs. 2022;21(1):59. Lennick D, Kiel F. Moral intelligence 2.0: Enhancing business performance and leadership success in turbulent times. Pearson Prentice Hall; 2011. Lennick D, Kiel F. Linking strong moral principles to business success. Pennsylvania, Wharton School of the University of Pennsylvania, 2005. 1(1): pp. 1–6. Majidi SA et al. Assessment of hospital nurses’ moral intelligence: A cross-sectional study in Guilan Province, north of Iran. Shiraz E-Medical J, 2018. 19(10). Kalisch BJ, Lee H, Salas E. The development and testing of the nursing teamwork survey. Nurs Res. 2010;59(1):42–50. Rahimmeh K, et al. Missed nursing care and its related factors from the points of view of nurses affiliated to Kerman University of Medical Sciences in 2017. Hayat. 2019;25(1):11–24. GORZIN H, et al. Nurses' Moral Intelligence in a Selected Military Hospital. A Descriptive-Analytical Study. Crit Care Nurs. 2019;12(2):28–34. Motlagh FG, Nobahar M, Raiesdana N. The relationship of moral intelligence and social capital with job satisfaction among nurses working in the emergency department. Int Emerg Nurs. 2020;52:100911. Jomaa C, et al. Staffing, teamwork and scope of practice: Analysis of the association with patient safety in the context of rehabilitation. J Adv Nurs. 2022;78(7):2015–29. Bragadóttir H, et al. The relationship of nursing teamwork and job satisfaction in hospitals. SAGE Open Nurs. 2023;9:23779608231175027. Chaboyer W, et al. Missed nursing care: An overview of reviews. Kaohsiung J Med Sci. 2021;37(2):82–91. Ahansaz N, Adib-Hajbaghery M, Baghaei R. Missed nursing care and its relationship with nurses’ moral sensitivity: a descriptive-analytical study. BMC Nurs. 2024;23(1):169. Xu X, et al. The Relationship Between Moral Sensitivity, Missed Nursing Care and Moral Distress Among New Nurses: A Cross-Sectional Study. Journal of Clinical Nursing; 2024. Campbell CM, et al. Variables associated with missed nursing care in Alabama: A cross-sectional analysis. J Nurs Adm Manag. 2020;28(8):2174–84. Zahra Hadian S, Raheleh S. Moral intelligence in nursing: An evolutionary concept analysis. Nurs Pract Today, 2021. 8(4). Karabey T. Reflection of nurses' moral intelligence levels on care behaviors. Perspect Psychiatr Care. 2022;58(4):1622–31. Fouladi E, Mohammadi MA, Mozaffari N. Predicting Missed Nursing Care Based on Moral Sensitivity and Care-Related Factors. J Nurs Midwifery Sci. 2024;11(2):e143728. Cohen M, Drach-Zahavy A, Srulovici E. The dual protective role of accountability: Mitigating missed nursing care and nurse moral distress in a nested diary study design . Journal of Clinical Nursing. Jones TL, Hamilton P, Murry N. Unfinished nursing care, missed care, and implicitly rationed care: State of the science review. Int J Nurs Stud. 2015;52(6):1121–37. Kalánková D, et al. Application of measuring tools in the assessment of the phenomenon of rationing/missed/unfinished care. Kontakt. 2019;21(1):65–73. Vincelette C, Thivierge-Southidara M, Rochefort CM. Conceptual and methodological challenges of studies examining the determinants and outcomes of omitted nursing care: A narrative review of the literature. Int J Nurs Stud. 2019;100:103403. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 29 Sep, 2025 Reviewers invited by journal 25 Sep, 2025 Editor assigned by journal 22 Sep, 2025 Editor invited by journal 28 Aug, 2025 Submission checks completed at journal 27 Aug, 2025 First submitted to journal 27 Aug, 2025 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-7329125","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":524850966,"identity":"4e9c4077-e228-4766-8857-2ed55d0a166b","order_by":0,"name":"Alireza Gholampour-Nooran","email":"","orcid":"","institution":"Ardabil University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Alireza","middleName":"","lastName":"Gholampour-Nooran","suffix":""},{"id":524850967,"identity":"00acd585-d2e6-42d2-a9d2-ad22ff313840","order_by":1,"name":"Fatemeh Bezaatpour","email":"","orcid":"","institution":"Ardabil University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Bezaatpour","suffix":""},{"id":524850968,"identity":"980f7670-154b-4300-a056-a06e1c3cd6af","order_by":2,"name":"Bita Hashemi","email":"","orcid":"","institution":"Ardabil University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Bita","middleName":"","lastName":"Hashemi","suffix":""},{"id":524850969,"identity":"282e45a7-afde-460b-92dc-10645590f0f8","order_by":3,"name":"Mehdi Ajri-Khameslou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYFCCA0DIwJDAcJgZREvIkKKFLQGkhYdouxIYDvAYgBiEtfA3nn14gDHHJo/vOM/nVzdqLHgY2A8f3YBPi8SB4wYHGLelFUse5t1mnXMM6DCetLQbeK05cIwBqOVw4gagFuMcNqAWCR4zvFrkIVr+A7XwPDPO+UeEFgOIlgMgLcyPc9uI0GII0pK4LTlx5mE2M+bcPgkeNkJ+kbtxjPnDx212iX3nDz/+nPOtTo6f/fAx/N6XOACKFDBgkwCTeJWDAH8DnMn8gaDqUTAKRsEoGJEAALnkT/u6ATxwAAAAAElFTkSuQmCC","orcid":"","institution":"Ardabil University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mehdi","middleName":"","lastName":"Ajri-Khameslou","suffix":""}],"badges":[],"createdAt":"2025-08-08 16:38:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7329125/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7329125/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92955303,"identity":"fc601591-9423-4d2b-93bf-d739c3195cf9","added_by":"auto","created_at":"2025-10-07 13:55:31","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":69502,"visible":true,"origin":"","legend":"","description":"","filename":"RelationshipBetweenMoralIntelligenceTeamworkandMissedNursingCaresinHospitalNursesACrossSectionalStudy11.docx","url":"https://assets-eu.researchsquare.com/files/rs-7329125/v1/076c44d01d0e104f19e57f72.docx"},{"id":92955678,"identity":"107ade27-0f10-4ee8-8832-f87848c41640","added_by":"auto","created_at":"2025-10-07 14:03:31","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":23756,"visible":true,"origin":"","legend":"","description":"","filename":"table.docx","url":"https://assets-eu.researchsquare.com/files/rs-7329125/v1/dbbad37705843fc16932d800.docx"},{"id":92956881,"identity":"49fe5e28-c321-4d29-990a-2bdb8ef79f6a","added_by":"auto","created_at":"2025-10-07 14:11:31","extension":"json","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6962,"visible":true,"origin":"","legend":"","description":"","filename":"3f02d229ba094e1482c4f1b3b64da31f.json","url":"https://assets-eu.researchsquare.com/files/rs-7329125/v1/5ebe6726e7f68b2acb0ecbd7.json"},{"id":92955308,"identity":"11f621b1-e3df-4f6d-9618-eccdad2c7f24","added_by":"auto","created_at":"2025-10-07 13:55:31","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":118643,"visible":true,"origin":"","legend":"","description":"","filename":"3f02d229ba094e1482c4f1b3b64da31f1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7329125/v1/ab418731a282f7796fc254aa.xml"},{"id":92955304,"identity":"fd9a4a7e-166a-4503-895c-d6a19a9b5aae","added_by":"auto","created_at":"2025-10-07 13:55:31","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1305,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7329125/v1/7d80f9725b8151cb668492ef.png"},{"id":92955306,"identity":"3370ea64-9e5c-49a7-8afa-e2a04259093c","added_by":"auto","created_at":"2025-10-07 13:55:31","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":410,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7329125/v1/2114b2de9f472f31eab7b501.png"},{"id":92955680,"identity":"d7a53f4e-a2eb-424a-8e2d-3e4e35131fd2","added_by":"auto","created_at":"2025-10-07 14:03:31","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":114822,"visible":true,"origin":"","legend":"","description":"","filename":"3f02d229ba094e1482c4f1b3b64da31f1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7329125/v1/c22ad116a206a68d0852648b.xml"},{"id":92955309,"identity":"34400496-f35b-492c-80df-ff85353a8f6f","added_by":"auto","created_at":"2025-10-07 13:55:31","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":127776,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7329125/v1/9dbe03b47d0b7cd113903565.html"},{"id":92957308,"identity":"68324b97-ee37-4702-a6e9-cbf76a5322e8","added_by":"auto","created_at":"2025-10-07 14:19:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":896366,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7329125/v1/aaba146a-ca40-4e4f-afb9-4f546c2b6830.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relationship between Moral Intelligence, Teamwork, and Missed Nursing Cares in Hospital Nurses: A Cross-Sectional Study","fulltext":[{"header":"What is already known","content":"\u003cul\u003e\n \u003cli\u003eMissed\u0026nbsp;nursing care is\u0026nbsp;crucial for measuring nursing quality\u0026nbsp;and patient\u0026nbsp;safety.\u003c/li\u003e\n \u003cli\u003eQuality and safety in care remains a top priority for the healthcare\u003c/li\u003e\n \u003cli\u003eThe literature has\u0026nbsp;not yet\u0026nbsp;identified\u0026nbsp;predictors of missed nursing care.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eWhat this paper adds\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe findings of this study show that gender, years of work experience, moral intelligence, and teamwork significantly predict missed nursing care.\u003c/li\u003e\n \u003cli\u003eImprovement of moral intelligence and teamwork can lead to a reduction in missed nursing care.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Background","content":"\u003cp\u003eIn healthcare, every professional is responsible for improving patients' health and well-being while working to prevent complications that arise from illnesses [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In the healthcare system, nurses have an important role in caring with patients [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Nursing can be seen as a model that includes physical, emotional, cognitive, and organizational work. These different types of work are often hidden and unnoticed. This framework emphasizes the supportive role of patient safety [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Nurses' caring involves visible and invisible caring [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A study conducted in Australia revealed that nurses dedicated approximately 37% of their time to patient care. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eConsidering the important role of nurses in caring for patients, nurses experience a moral climate. The ethical climate in the care system significantly impacts the safety of patients and the results of care and treatment. Because of the importance of this issue, the ethical climate in nursing was defined as a way to understand how to handle ethical issues in their specific work environment [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eVictor and Cullen first introduced the concept of \"ethical climate\" in 1988. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, knowing and applying ethical principles is directly related to human intelligence [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Intelligence can be described as a broad mental capacity for reasoning, problem-solving, and learning [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Moral intelligence was introduced as a concept in 2005 by Doug Lennick and Fred Kiel: \"Moral intelligence is the capacity to understand right from wrong, to have strong ethical convictions and to act on them to behave in the right and honorable way.\" [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A cross-sectional study in Iran (2023) found that nurses with elevated moral intelligence demonstrate a more substantial commitment to patient safety protocols, and the moral intelligence of nurses helps them to think carefully and make more measured decisions before each action [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Also, paying more attention to moral intelligence as a mediator to properly manage personality traits that are effective in reducing nurses' burnout can lead to improving the quality of nursing care [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. On the other hand, factors such as moral values, individual abilities, skills, family history, work experience, social status, psychological factors like perceptions, roles, attitudes, personality, motivation, work environment, job satisfaction, and organizational behaviors and decisions of nurses all have an effect [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGhezeljeh et al. (2021) found that teamwork is an effective solution for enhancing the quality of care [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and effective teamwork is necessary for conducting patient safety [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Teamwork is \u0026ldquo;a group of employees who do a job assigned by the leader\u0026rdquo; [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Emich (2018) defined nursing teamwork as \u0026ldquo;an interprofessional process where nurses and other healthcare members work together to solve patient care issues, emphasizing respect and shared knowledge\u0026rdquo; [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. It has dimensions such as leadership, a shared understanding of roles, and mutual respect among team members [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Hassan et al. (2024) conducted a quasi-experimental pretest-posttest study on newly graduated nurses. In this study, educational intervention was done using the TeamSTEPPS training program. The results demonstrated improved perceptions of teamwork and patient safety culture after TeamSTEPPS training, with significant improvements [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Also, better teamwork causes higher patient satisfaction and better care continuity [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMissed nursing care is an important concept to understand and measure the quality of nursing and patient safety [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. It encompasses any care component that is either omitted or delayed, partially or entirely. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Factors such as human resources, material, communication, adequacy of nursing staff, satisfaction with income, and working in a medical unit are important reasons nurses identify for missed care [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. A systematic review conducted to investigate missed nursing care in low-income and middle-income countries showed that the prevalence of missed nursing care ranges from 15.2\u0026ndash;86%[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] based on studies of overall average care. Missed care in Saudi Arabia was 1.37 [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], United States 1.71[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], Australia 2.02 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], South Korea 1.40 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], Egypt 2.26 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], and Jordan was 2.78 [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The average in Iranian hospitals was 2.57, and 72.1% of nurses reported missing at least one nursing care item in their last working shift [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. A cross-sectional study conducted by White et al. (2024) found that missed nursing care is associated with inadequate time or resources and it can lead to burnout and job dissatisfaction in the nurses [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLow patient safety leads to approximately 134\u0026nbsp;million adverse events, leading to 2.6\u0026nbsp;million deaths in low- and middle-income countries [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Janatolmakan et al. (2022), in a qualitative descriptive study, concluded that the organization-related consequences of missed nursing care are increased costs, reduced organizational credibility, absenteeism, intention to leave, and subsequent turnover. So they concluded that the healthcare centers need to increase nurses\u0026rsquo; job satisfaction and encourage them to report this type of care [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEvidence indicates that missed care is prevalent in many medical centers, posing a significant risk to patient safety. Additionally, missed care impacts nurses' performance and job satisfaction. This raises an important question: how can we reduce the frequency of missed care among nurses? This study aims to explore the relationship between moral intelligence, teamwork, and the factors contributing to missed nursing care, with the goal of improving job satisfaction for nurses and enhancing patient safety to ultimately improve treatment outcomes.\u003c/p\u003e"},{"header":"Research Methodology","content":"\u003cp\u003eThis cross-sectional, descriptive, and correlational study was carried out from November to February 2023 and included 300 nurses who fulfilled the sampling criteria with a stratified random sampling method. The sample size was determined to be 330 nurses using this formula (z\u0026thinsp;=\u0026thinsp;1.96, p\u0026thinsp;=\u0026thinsp;0.5, q\u0026thinsp;=\u0026thinsp;0.5, 10% dropout rate).\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:n=\\:\\frac{\\frac{{z}^{2}pq}{{d}^{2}}}{1+\\:\\frac{1}{N}\\:\\left[\\frac{{z}^{2}pq}{{d}^{2}}-1\\right]}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eNurses who provided informed consent and had more than six months of experience working in five teaching hospitals in Ardabil city, located in Northwest Iran, were included in the study. Nurses working in delivery rooms and operating rooms who were not directly involved in patient care were excluded. A total of 330 questionnaires were distributed, and 310 responses were received, of which 300 were valid, resulting in a valid return rate of 90.9%.\u003c/p\u003e\u003cp\u003eThe data collection instruments included the demographics form, Lennick and Kiel\u0026rsquo;s moral intelligence short-form questionnaire, Kalish\u0026rsquo;s teamwork questionnaire, and Kalish\u0026rsquo;s missed nursing care questionnaire (MISSCARE).\u003c/p\u003e\u003cp\u003eThe demographic information questionnaire included age, gender, marital status, gender, working years, education, employment status, position, and Ward.\u003c/p\u003e\u003cp\u003eThe Moral Intelligence Questionnaire, designed and developed by Lennick and Kiel in 2005, consists of 20 items that assess various aspects of moral intelligence. This survey includes three subscales: honesty (with 12 questions), forgiveness, and compassion (each containing 4 questions). Participants respond using a 5-point Likert scale, where 1 means \"never\" and 5 means \"always.\" The total score can range from 20 to 100, with the following categories: a score of 20\u0026ndash;33 indicates low moral intelligence, 34\u0026ndash;66 indicates moderate moral intelligence, and 67\u0026ndash;100 indicates high moral intelligence [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In a study conducted in Iran, Majidi and et al evaluated the reliability of this questionnaire and found a Cronbach's alpha of 0.83, which indicates good reliability [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In our study, the Cronbach's alpha for this questionnaire was found to be 0.90, indicating excellent reliability. In this study, Cronbach's alpha was 0.9 for this questionnaire.\u003c/p\u003e\u003cp\u003eThe Kalisch teamwork questionnaire (NTS) (2010) contains 33 items divided into five subscales: trust (7 items), awareness of teamwork (9 items), mutual support (6 items), team leadership (4 items), and shared mental model (7 items). Responses are measured on a 5-point Likert scale, ranging from \"never\" to \"always\". The mean score of the items is considered the teamwork score. The minimum and maximum scores on the scale are 1 and 5, respectively; higher scores reflect better teamwork among nurses. The Cronbach's alpha for this questionnaire was also reported as 0.83, suggesting it is a reliable tool for assessing teamwork [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Since the original questionnaire was in English, we translated it into Persian for our study. In this study, Cronbach's alpha was 0.93.\u003c/p\u003e\u003cp\u003eFor measuring missed nursing care (MNC), the MISSCARE Survey was employed, which was developed by Kalisch and Williams (2009). In total, 24 items ask about the type and frequency of missed nursing care, using a 4-point Likert scale from \"rarely\u0026thinsp;=\u0026thinsp;1\" to \"always\u0026thinsp;=\u0026thinsp;4\". The total scores range from 24 to 96, where a higher score indicates a greater likelihood of missed care [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Khajavi et al. assessed the content and face validity of this questionnaire, finding it suitable for use. Their study reported a Cronbach's alpha of 0.91, indicating strong reliability [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. In this study, Cronbach's alpha was obtained as 0.94 for this questionnaire.\u003c/p\u003e\u003cp\u003eAfter obtaining permission for the study from each hospital's nursing department, data were collected from August to September 2022. Informed consent forms for study participation were signed before the start of the study. Anonymized blank envelopes were provided for the participants to place the completed questionnaire in the envelope, seal it, and return it.\u003c/p\u003e\u003cp\u003e The Research Ethics Committee of Ardabil University of Medical Sciences approved this study. Informed consent was obtained from the nurses. The study is congruent with the Declaration of Helsinki regarding medical research involving human subjects.\u003c/p\u003e\u003cp\u003eData were analyzed using SPSS version 15, descriptive statistics (mean and standard deviation), and inferential statistics (one-sample T-test, independent T-test, one-way ANOVA, Pearson's correlation coefficients, and linear regression). The data has a normal distribution (Kolmogorov-Smirnov normality test with a p-value\u0026thinsp;=\u0026thinsp;0.05). The significance level was 0.05. The JBI guidelines for observational studies and the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist ensure comprehensive and transparent reporting of our findings.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOur sample of 300 nurses comprised 241 females (80.3%) and 59 males (19.7%). The age of the nurses was between 22 and 52 years old (mean: 33.59\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8). About 80% of the nurses were female, 40% of the nurses had worked fewer than 7 years, and the mean (\u0026plusmn;\u0026thinsp;SD) of total working years was 9.55 (\u0026plusmn;\u0026thinsp;6.1). The descriptive characteristics of the nurses are represented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eDemographic Characteristics of Nurses (N\u0026thinsp;=\u0026thinsp;300 surveys)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22\u0026ndash;32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32\u0026ndash;42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42\u0026ndash;52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e241\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eWork Experience (year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.5-7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u0026ndash;21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21\u0026ndash;28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e287\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaster's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePosition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSupervisor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHead Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStaff Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eWard\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmergency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObstetrics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePediatrics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntensive care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedical \u0026ndash; Surgical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe mean score (\u0026plusmn;\u0026thinsp;SD) of moral intelligence was 74.41 (\u0026plusmn;\u0026thinsp;10.61), indicating an acceptable level of moral intelligence in 82.3% of nurses. The mean score (\u0026plusmn;\u0026thinsp;SD) of teamwork was 3.37 (\u0026plusmn;\u0026thinsp;0.6), and the results showed that the highest mean score of teamwork was for the dimension of \"Trust\" (3.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74), and the lowest one was for the dimension of \"Shared mental model\" (3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63), 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\u003e\u003cb\u003eDescriptive Statistics of Moral Intelligence and Teamwork\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubscales\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of items\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eMoral intelligence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHonesty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eForgiveness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCompassion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e74.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eTeamwork\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrust\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeamwork awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMutual support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeam leadership\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eShared mental model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.6\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\u003eThe mean (\u0026plusmn;\u0026thinsp;SD) of missed nursing care was 37.3 (\u0026plusmn;\u0026thinsp;11.83). Nurses with more working years had fewer missed care (P\u0026thinsp;=\u0026thinsp;0.001). The male nurses had more missed care (41.16\u0026thinsp;\u0026plusmn;\u0026thinsp;12.15) than the female nurses (36.36\u0026thinsp;\u0026plusmn;\u0026thinsp;12.15). The relationship between the nurses' demographic characteristics and missed care is provided in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eDemographic characteristics of nurses participating in the research and its relationship with the Missed Nursing Care\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22\u0026ndash;32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32\u0026ndash;42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42\u0026ndash;52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.007**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eWorking years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.5-7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u0026ndash;21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21\u0026ndash;28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.674\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaster's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePosition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSupervisor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.077\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHead Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStaff Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eWard\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmergency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e0.207\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObstetrics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.68\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePediatrics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntensive care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedical \u0026ndash; Surgical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMissed Nursing Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e11.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e* One-way ANOVA, ** Independent t-test\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\u003e The regression analysis results show that gender, working years, moral intelligence, and teamwork are among the factors affecting the non-implementation of nursing care. Improvements in these factors can help reduce non-compliance with care. This value shows that these four independent variables explain 15.7% of the variance in non-implementation of care. With the increase in working years, the rate of non-implementation of care decreases. Increasing moral intelligence and improving teamwork can lead to a reduction in non-compliance with care. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e demonstrates the Predictors of Missed Nursing Care.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eMultivariable Regression Factors Influencing Missed Nursing Care\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIndependent variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eUnstandardized Coefficients\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eꞵ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e95% Cl\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLower\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUpper\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Constant)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73.947\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.528\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.377\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e63.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e84.827\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-3.476\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.621\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-6.666\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.286\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-2.593\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.787\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-3.293\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-4.143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-1.043\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMoral Intelligence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.284\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTeamwork\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-4.224\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-3.617\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-6.522\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-1.926\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eAdj R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.157, F\u0026thinsp;=\u0026thinsp;14.941, \u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.001\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\u003e This study examines the phenomenon of missed nursing care and its relationship with moral intelligence and teamwork among hospital nurses. The majority of the nurses demonstrated high levels of moral intelligence, which aligns with previous findings. Heidari et al. (2022) conducted an assessment of moral intelligence, burnout, and the quality of nursing care in a sample of 125 nurses in Mazandaran, Iran. Their results indicated that the overall score of nurses\u0026rsquo; moral intelligence was satisfactory [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Consistent results were reported by Gorzin et al. (2019) [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Also, Motlagh et al. (2019) conducted a cross-sectional study among 99 nurses working in the emergency department, finding comparable results [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. The high level of moral intelligence of nurses is due to the nature of their profession. Therefore, teaching ethical intelligence to nurses and encouraging staff with higher ethical intelligence enhances their reasoning, problem-solving, and ability to cope with problems. The mean score (\u0026plusmn;\u0026thinsp;SD) of Teamwork was 3.37 (\u0026plusmn;\u0026thinsp;0.6), and the highest mean score of Teamwork was for the dimension of \u0026ldquo;Trust\u0026rdquo; (3.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74); also, the lowest one was for the dimension of \u0026ldquo;Shared mental model\u0026rdquo; (3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63). Jomaa et al. (2020) conducted a correlational study among 75 nursing staff members in rehabilitation units. They found a teamwork score of 3.36 (SD\u0026thinsp;=\u0026thinsp;0.58), which was moderate. Also, Shared Mental Model had the highest mean, 3.84 (\u0026plusmn;\u0026thinsp;0.6), and Team Orientation 3.02 (0.69) had the lowest mean among the dimensions of nursing teamwork [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. In a study conducted by Bragad\u0026oacute;ttir et al. (2023) involving 567 participants, the overall mean teamwork score was found to be 3.89 (\u0026plusmn;\u0026thinsp;0.47). Among the subthemes, the Shared Mental Model received the highest mean score of 4.20 (\u0026plusmn;\u0026thinsp;0.48), while team leadership had the lowest mean score of 3.65 (\u0026plusmn;\u0026thinsp;0.75) [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The different levels of teamwork among nurses depend on their definition of teamwork and their personality type. Therefore, it is suggested to carry out studies on the relationship between the personality type of nurses and the levels of physical activity and its effect on the safety of patients. The mean score (\u0026plusmn;\u0026thinsp;SD) of missed nursing care was 37.3 (\u0026plusmn;\u0026thinsp;11.83), which means around 39.6% of nursing care was missed. In the study of Dirgar et al. (2024), the mean score (\u0026plusmn;\u0026thinsp;SD) of missed nursing care was 30.82 (\u0026plusmn;\u0026thinsp;7.30), indicating that the nurses exhibited lower levels of missed nursing care compared to the average [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], which is consistent with our findings. Contrary to this, Kassahun et al. (2022) revealed that nearly 63% of nursing care was missed [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In different studies, the missed care reported by nurses is different and varied [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. The reason for this discrepancy is the reediness of nurses, organization-related factors, and continuous training of nurses. Regression analyses showed that missed nursing care was affected by gender, and male nurses significantly had more missed care than females, and nurses with more working years had fewer missed care. Studies have reported that influencing factors on missed nursing care, such as age, work experience, and workload, significantly influence missed care. [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Campbell (2020) reported that female nurses reported higher levels of missed care than males [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. This study's findings suggest that moral intelligence can predict missed nursing care. While previous research hasn't explicitly established this link, related findings have been reported. For instance, Shirazi et al. (2021) performed a concept analysis showing that higher moral intelligence supports nurses' personal and professional growth. This development promotes holistic care and boosts organizational performance, resulting in improved quality of health services. [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Moreover, Karabey et al. (2021) found that it is essential to determine moral intelligence levels, which directly affect nursing care, and the quality of the care provided [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Fouladi et al. (2021) in a study to predict Missed Nursing Care Based on Moral Sensitivity, reported that the components of moral sensitivity explain missed care. [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. These findings indicate that moral intelligence directly affects personal accountability, conscientiousness, decision-making, and awareness, thereby decreasing the occurrence of missed nursing care. [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Teamwork has been found to be a predictor of missed nursing care. Our study aligns with a review conducted by Jones et al. (2015), which revealed that a significant majority (55\u0026ndash;98%) of nursing staff reported leaving one or more tasks unfinished. Key factors in the nursing work environment\u0026mdash;such as time constraints, resource availability, and teamwork\u0026mdash;were identified as having moderately negative effects on the occurrence of missed nursing care. Additionally, the review indicated that nurses often experience moral distress, role conflict, and role strain as a result of missed care [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Kal\u0026aacute;nkov\u0026aacute; et al. (2019) found that teamwork levels strongly predict adverse patient and nursing outcomes, and serve as indicators of care quality. [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Recent research highlights that implementing targeted strategies to enhance essential teamwork skills\u0026mdash;such as fostering teamwork awareness, encouraging mutual support among team members, and developing strong team leadership\u0026mdash;can significantly diminish the chances of overlooked nursing care. By cultivating these vital skills, healthcare teams can create a more cohesive and efficient working environment, ultimately leading to improved patient outcomes and a higher standard of care. [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eStrengths and Limitations\u003c/h3\u003e\n\u003cp\u003eOne of the most important limitations of the research is the enormous workload of nurses and the lack of time to fill out the questionnaire, which may have led to inaccurate responses. In addition to this, the mental conditions and motivation level of the nurses and their willingness and accuracy in answering the questions may affect the results.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study showed an acceptable level of moral intelligence, moderate teamwork, and a low level of missed care in nurses. Gender, working years, moral intelligence, and teamwork significantly predict missed nursing care.\u003c/p\u003e\n\u003ch3\u003eImplications for Nursing Management\u003c/h3\u003e\n\u003cp\u003eImprovement of moral intelligence and teamwork can lead to a reduction in missed nursing care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate:\u003c/strong\u003e\u003cp\u003e The present study is a research project approved by the Student Research Committee of the School of Nursing and Midwifery, Ardabil University of Medical Sciences, with the ethics code IR.ARUMS.REC.1403.035. \u003cb\u003eAll participants in the study provided informed consent\u003c/b\u003e. Consent for publication: Authors have all rights to the data and full consent to publish this paper. The Helsinki Declaration, which was about the ethical standards of medical research on human subjects, was used to conduct the study.\u003c/p\u003e\u003ch2\u003eCompeting interests:\u003c/h2\u003e\u003cp\u003eThe authors have no relevant financial or nonfinancial interests to disclose. The authors have no competing interests to declare relevant to this article's content. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial Interest in the subject matter or materials discussed in this manuscript. The author(s) declare that they have no conflict of Interest.\u003c/p\u003e\u003ch2\u003eConsent for publication:\u003c/h2\u003e\u003cp\u003eNot Applicable\u003c/p\u003e\u003ch2\u003eClinical trial number\u003c/h2\u003e\u003cp\u003enot applicable\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAlireza Gholampour-Nooran was the primary principal investigator, responsible for the preparation of the manuscript, data analysis, and data gathering. Fatemeh Bezaatpour designed the work, contributed to writing the Final approval draft, and performed data gathering and analysis. Bita Hashemi contributed to management and coordination in the research activity, planning, and execution, and helped with English translation. Mehdi Ajri-Khameslou designed the overarching research goals and aims, methodology, data analysis, and preparation of the initial and final draft.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e This article is undertaken from a research project of the Student Research Committee at Ardabil University of Medical Sciences with the code of ethics (IR.ARUMS.REC.1403.035). We are grateful to all the nurses who participated in the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to the participants' dissatisfaction with the institution. However, they are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSim J, et al. Development of a data registry to evaluate the quality and safety of nursing practice. J Adv Nurs. 2019;75(9):1877\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMiao Q, et al. The Role of Nursing Care in the Management of Patients with Traumatic Subarachnoid Hemorrhage. Galen Med J. 2023;12:1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJackson J, Anderson JE, Maben J. What is nursing work? A meta-narrative review and integrated framework. Int J Nurs Stud. 2021;122:103944.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAllen D. The invisible work of nurses: Hospitals, organisation and healthcare. Routledge; 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWestbrook JI, et al. How much time do nurses have for patients? A longitudinal study quantifying hospital nurses' patterns of task time distribution and interactions with health professionals. BMC Health Serv Res. 2011;11:1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOzdoba P, et al. Hospital ethical climate and job satisfaction among nurses: A scoping review. Int J Environ Res Public Health. 2022;19(8):4554.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOlson L. Ethical climate in health care organizations. Int Nurs Rev. 1995;42(3):85\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEbrahim Abdel Aty A, Ibrahim Mahmoud S, Ibrahim Ismail Z. Ethical Work Climate and its relation to Patients' Safety as Perceived by Staff Nurses. J Nurs Sci Benha Univ. 2024;5(2):381\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVictor B, Cullen JB. \u003cem\u003eThe organizational bases of ethical work climates.\u003c/em\u003e Administrative science quarterly, 1988: pp. 101\u0026ndash;125.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShirazi ZH, Sabetsarvestani R. Moral intelligence in nursing: an evolutionary concept analysis. Nursing Practice Today; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGottfredson LS. Intelligence: is it the epidemiologists' elusive fundamental cause of social class inequalities in health? J Personal Soc Psychol. 2004;86(1):174.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchmidt FL, Hunter J. General mental ability in the world of work: occupational attainment and job performance. J Personal Soc Psychol. 2004;86(1):162.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eD FKP, Lennick D. Moral Intelligence: Enhancing Business Performance and Leadership Success. Pearson Education; 2005.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRanjbar M, et al. Investigating the Relationship between Moral Intelligence and Attitude towards Patient Safety in Nurses Working at Shahid Sadoughi Teaching Hospital in Yazd in 2023. Quarterly Journal of Management Strategies in Health System; 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHeidari T, et al. Association between moral intelligence, burnout and quality of nursing care. London, England: SAGE Publications Sage UK; 2022. pp. 334\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWidayati CC et al. \u003cem\u003eThe Effect of Emotional Intelligence, Teamwork, Organizational Culture and Empathy on Employee Performance\u003c/em\u003e. in \u003cem\u003e4th Social and Humanities Research Symposium (SoRes 2021)\u003c/em\u003e. 2022. Atlantis Press.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGhezeljeh TN, Gharasoflo S, Haghani S. The relationship between missed nursing care and teamwork in emergency nurses: a predictive correlational study. Nurs Pract Today. 2021;8(2):103\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNobahar M, Ameri M, Goli S. The relationship between teamwork, moral sensitivity, and missed nursing care in intensive care unit nurses. BMC Nurs. 2023;22(1):241.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSinambela LP. Manajemen Sumber Daya Manusia: Membangun tim kerja yang solid untuk meningkatkan kinerja. Bumi Aksara; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEmich C. \u003cem\u003eConceptualizing collaboration in nursing\u003c/em\u003e. in \u003cem\u003eNursing forum\u003c/em\u003e. Wiley Online Library; 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRyan S. Promoting effective teamwork in the healthcare setting. Nurs standard, 2017. 31(30).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHassan AE, et al. Evaluating the Effect of TeamSTEPPS on Teamwork Perceptions and Patient Safety Culture among Newly Graduated Nurses. BMC Nurs. 2024;23(1):170.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDighrir mohamadhassanA. The Collaborative Pulse of Healthcare: a critical analysis of Nursing\u0026rsquo;s Role in a Holistic Approach to Patient Care Across Medical Specialties. J Ecohumanism. 2024;3(7):2889\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChapman R, et al. Impact of teamwork on missed care in four Australian hospitals. J Clin Nurs. 2017;26(1\u0026ndash;2):170\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKalisch BJ, Williams RA. Development and psychometric testing of a tool to measure missed nursing care. JONA: J Nurs Adm. 2009;39(5):211\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChegini Z, et al. Missed nursing care and related factors in Iranian hospitals: A cross-sectional survey. J Nurs Adm Manag. 2020;28(8):2205\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKassahun CW, et al. Missed nursing care and associated factors among nurses at University of Gondar Comprehensive Specialized Hospital, Ethiopia, 2022. Sci Rep. 2024;14(1):25571.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eImam A, et al. Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review. Hum Resour Health. 2023;21(1):1\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl Muharraq EH et al. \u003cem\u003eAn Overview of Missed Nursing Care and Its Predictors in Saudi Arabia: A Cross-Sectional Study.\u003c/em\u003e Nursing Research and Practice, 2022. 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKalisch BJ, et al. Missed nursing care, level of staffing, and job satisfaction. J Nurs Adm. 2013;43(5):274\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrique SB, Patty CM, Woods E. Missed nursing care and unit-level nurse workload in the acute and post-acute settings. J Nurs Care Qual. 2016;31(1):84\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHammad M, Guirguis W, Mosallam R. Missed nursing care, non-nursing tasks, staffing adequacy, and job satisfaction among nurses in a teaching hospital in Egypt. J Egypt Public Health Assoc. 2021;96(1):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSaqer TJ, AbuAlRub RF. Missed nursing care and its relationship with confidence in delegation among hospital nurses. J Clin Nurs. 2018;27(13\u0026ndash;14):2887\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWhite EM, Aiken LH, McHugh MD. Registered Nurse Burnout, Job Dissatisfaction, and Missed Care in Nursing Homes. J Am Geriatr Soc. 2019;67(10):2065\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDhingra-Kumar N, Brusaferro S, Arnoldo L. \u003cem\u003ePatient safety in the world.\u003c/em\u003e textbook of patient safety and clinical risk management, 2021: pp. 93\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJanatolmakan M, Khatony A. Explaining the consequences of missed nursing care from the perspective of nurses: a qualitative descriptive study in Iran. BMC Nurs. 2022;21(1):59.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLennick D, Kiel F. Moral intelligence 2.0: Enhancing business performance and leadership success in turbulent times. Pearson Prentice Hall; 2011.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLennick D, Kiel F. \u003cem\u003eLinking strong moral principles to business success.\u003c/em\u003e Pennsylvania, Wharton School of the University of Pennsylvania, 2005. 1(1): pp. 1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMajidi SA et al. Assessment of hospital nurses\u0026rsquo; moral intelligence: A cross-sectional study in Guilan Province, north of Iran. Shiraz E-Medical J, 2018. 19(10).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKalisch BJ, Lee H, Salas E. The development and testing of the nursing teamwork survey. Nurs Res. 2010;59(1):42\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRahimmeh K, et al. Missed nursing care and its related factors from the points of view of nurses affiliated to Kerman University of Medical Sciences in 2017. Hayat. 2019;25(1):11\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGORZIN H, et al. Nurses' Moral Intelligence in a Selected Military Hospital. A Descriptive-Analytical Study. Crit Care Nurs. 2019;12(2):28\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMotlagh FG, Nobahar M, Raiesdana N. The relationship of moral intelligence and social capital with job satisfaction among nurses working in the emergency department. Int Emerg Nurs. 2020;52:100911.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJomaa C, et al. Staffing, teamwork and scope of practice: Analysis of the association with patient safety in the context of rehabilitation. J Adv Nurs. 2022;78(7):2015\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBragad\u0026oacute;ttir H, et al. The relationship of nursing teamwork and job satisfaction in hospitals. SAGE Open Nurs. 2023;9:23779608231175027.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChaboyer W, et al. Missed nursing care: An overview of reviews. Kaohsiung J Med Sci. 2021;37(2):82\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhansaz N, Adib-Hajbaghery M, Baghaei R. Missed nursing care and its relationship with nurses\u0026rsquo; moral sensitivity: a descriptive-analytical study. BMC Nurs. 2024;23(1):169.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXu X, et al. The Relationship Between Moral Sensitivity, Missed Nursing Care and Moral Distress Among New Nurses: A Cross-Sectional Study. Journal of Clinical Nursing; 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCampbell CM, et al. Variables associated with missed nursing care in Alabama: A cross-sectional analysis. J Nurs Adm Manag. 2020;28(8):2174\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZahra Hadian S, Raheleh S. Moral intelligence in nursing: An evolutionary concept analysis. Nurs Pract Today, 2021. 8(4).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarabey T. Reflection of nurses' moral intelligence levels on care behaviors. Perspect Psychiatr Care. 2022;58(4):1622\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFouladi E, Mohammadi MA, Mozaffari N. Predicting Missed Nursing Care Based on Moral Sensitivity and Care-Related Factors. J Nurs Midwifery Sci. 2024;11(2):e143728.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCohen M, Drach-Zahavy A, Srulovici E. \u003cem\u003eThe dual protective role of accountability: Mitigating missed nursing care and nurse moral distress in a nested diary study design\u003c/em\u003e. Journal of Clinical Nursing.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJones TL, Hamilton P, Murry N. Unfinished nursing care, missed care, and implicitly rationed care: State of the science review. Int J Nurs Stud. 2015;52(6):1121\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKal\u0026aacute;nkov\u0026aacute; D, et al. Application of measuring tools in the assessment of the phenomenon of rationing/missed/unfinished care. Kontakt. 2019;21(1):65\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVincelette C, Thivierge-Southidara M, Rochefort CM. Conceptual and methodological challenges of studies examining the determinants and outcomes of omitted nursing care: A narrative review of the literature. Int J Nurs Stud. 2019;100:103403.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Moral Intelligence, Teamwork, Missed Nursing Care, Nurse","lastPublishedDoi":"10.21203/rs.3.rs-7329125/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7329125/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eEnsuring quality and safety in care remains a top priority for the healthcare. Insufficient nurse staffing and missed care are linked to lower care standards and the occurrence of adverse events. This study aimed to illustrate the relationship between moral intelligence, teamwork, and missed nursing care, and how moral intelligence and teamwork affect quality of care and adverse hospital events.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis correlational study included 300 nurses in teaching hospitals with a stratified random sampling method. The participants completed Lennick and Kiel\u0026rsquo;s moral intelligence questionnaire and the Teamwork and MISSCARE questionnaire. The JBI guideline and STROBE checklist were followed for reporting in the study. Descriptive statistics, independent T-test, one-way ANOVA, and Multivariable regression models were used to estimate associations.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003e The mean score (\u0026plusmn;\u0026thinsp;SD) of moral intelligence, teamwork, and missed nursing care was 74.41 (\u0026plusmn;\u0026thinsp;10.61), 3.37 (\u0026plusmn;\u0026thinsp;0.6), and 37.3 (\u0026plusmn;\u0026thinsp;11.83). This showed an acceptable level of moral intelligence, moderate teamwork, and a low level of missed care in nurses. Nurses with more working years had fewer missed care, and the male nurses had more missed care (41.16\u0026thinsp;\u0026plusmn;\u0026thinsp;12.15) than the female nurses (36.36\u0026thinsp;\u0026plusmn;\u0026thinsp;12.15). The regression analysis results show that gender, working years, moral intelligence, and teamwork significantly predict missed nursing care.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003e This study showed an acceptable level of moral intelligence, moderate teamwork, and a low level of missed care in nurses. Gender, working years, moral intelligence, and teamwork significantly predict missed nursing care.\u003c/p\u003e\u003ch2\u003eImplications for Nursing Management:\u003c/h2\u003e\u003cp\u003eEnhancing moral intelligence and ensuring sufficient resources are recommended to reduce missed nursing care, prevent adverse events, and improve the quality of care.\u003c/p\u003e","manuscriptTitle":"Relationship between Moral Intelligence, Teamwork, and Missed Nursing Cares in Hospital Nurses: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-07 13:55:27","doi":"10.21203/rs.3.rs-7329125/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"210228676509917076403290457052062962652","date":"2025-09-29T09:32:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-25T08:54:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-22T17:39:04+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-28T19:18:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-27T08:33:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-08-27T08:29:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9b65b96a-f3cf-4ec9-9f31-6930db85b6e4","owner":[],"postedDate":"October 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-07T13:55:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-07 13:55:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7329125","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7329125","identity":"rs-7329125","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}