Insights into the relationship between professional values and caring behavior among nurses in neonatal intensive care units

Nursing stands as one of the most respected professions, deeply rooted in unwavering professional ethics and values [1]. Professional nursing values are defined as significant nursing principles that support professional practice, evaluation, and principles [2]. These values provide a framework for assessing the beliefs influencing professional performance and serve as endorsed guidelines by professional experts [3]. These principles include human dignity, altruism, integrity, and justice. They form the basis of nursing practice and the guidelines by which nurses should interact with patients and other professionals when making clinical decisions [1, 4, 5]. A profound comprehension of professional values and their profound impact on professional behavior is paramount for nurses [6].

According to Tehranineshat et al. (2020) [7], nurses utilize professional values to guide their decision-making, care practices, and ethical problem-solving when interacting with both well and sick patients. Studies of nurses’ professional values reveals a positive correlation between these values and motivation, career advancement, burnout, and satisfaction with compassion [7‐9]. These findings underscore the significance of internalizing professional values for fostering a positive work attitude, enhancing work commitment, and delivering high-quality care [10].

The notion of caring stands one of nursing’s fundamental and universal values, anchoring its essence and significance within the profession [11, 12]. At the core of nursing lies the essential value of care, serving as a cornerstone of the discipline [13, 14]. Assisting patients in achieving greater levels of mental, physical, and spiritual wellness is the main objective of nursing care [15]. There are two types of care: expressive care and technical care [15, 16]. While expressive care involves interactions that express hope, trust, and emotional support—such as appreciating patients, actively listening to them, and assist of their demands —technical care entails proficiency in the skills necessary to make sure the physical wellbeing and comfort of the patient [16]. This was accomplished by means of transpersonal relationships and compassionate interactions [17].

Health care is delivered by nurses on the front lines. Nurses must exhibit both technical and expressive care behaviors because patient-centered care has become increasingly important in the health services [18]. As part of their professional roles and responsibilities, nurses are also expected to provide services that demonstrate their competence to guarantee patient safety, high-quality care, and satisfaction with the hospital experience [19]. A safe and efficient nursing care delivery system depends on neonatal nurses, who play a variety of roles in the neonatal unit, supporting and addressing the various needs of families and the infants [20]. NICU nurses offer a range of nursing care and treatments to infants, including oxygen therapy, nutritional supplementation, mechanical ventilation, infection prevention, maintenance of vital signs, and pain management and prevention [21, 22].

Neonatal nurses play important roles in shaping neonatal health policy, managing inpatient and healthcare systems, advocating for neonates and their families, and providing direct care. professional values support nursing practice and are crucial for delivering compassionate care. However, despite the significance of these values for neonatal nurses working under intensive conditions in the critical care units, there has been limited research specifically examining how these values influence the caring behaviors exhibited in NICUs [14, 23, 24]. For instance, a study conducted in Saudi Arabia found that the majority of NICU nurses scored highly on perceived caring behaviors [14]. Additionally, an Iranian study reported that the professional values of NICU nurses had good mean ratings and emphasized that the advancement of the nursing profession depends on the development of nurses’ professional values [24].

Professional values and caring behaviors of nurses exhibit notable variations across different countries and cultures, reflecting the diverse socio-cultural contexts in which they operate [25]. In Western countries, such as the United States and many European nations, nursing often emphasizes individual autonomy, patient rights, and evidence-based practice [26]. This focus aligns with broader cultural values of individualism and personal empowerment. Conversely, in many Asian countries, including Japan and China, nursing practices may prioritize collective well-being, familial roles, and hierarchical structures, reflecting cultural values of collectivism and respect for authority [27]. These cultural differences impact how nurses perceive their roles and responsibilities, shaping their professional values and behaviors. For example, nurses in collectivist cultures might exhibit a higher degree of deference to family wishes and traditional practices, whereas those in individualist cultures might advocate more strongly for patient autonomy and self-determination [27]. Despite these differences, there is a common thread of commitment to compassionate care and ethical practice, underscoring a universal core of nursing professionalism that transcends cultural boundaries. Understanding these variations is crucial for fostering cross-cultural competence in nursing and enhancing the global practice of nursing care.

NICUs nurses are highly specialized professionals working in a high-stress-environment where their professional values are crucial for ensuring the survival and wellbeing of critically ill newborns [28]. They are responsible for both the technical and expressive aspects of care, making their professional values integral to the quality of care they provide. Consequently, the quality of their care services can impact key health indicators of societal health, including the Maternal Mortality Ratio and Infant Mortality Rate as well as parental satisfaction [29].

To our knowledge, no previous studies have explored the relationship between professional values and caring behaviors among NICU nurses in Palestine. Therefore, this study aims to assess this relationship and fill the existing gap in the literature, providing insights that can enhance the quality of care and professional development in NICUs.

An essential and distinctive hallmark of nursing, care encompasses several dimensions and is profoundly influenced by the personal and professional characteristics of nurses. Numerous studies have extensively explored the multifaceted nature of nurses’ care [37‐39]. Nurses base their decisions, problem-solving, patient care, community contributions, and teamwork on their professional beliefs rather than personal ones [37]. Therefore, this study aimed to assess the relationship between nurses’ professional values and caring behaviors among nurses working in neonatal intensive care units in Palestine.

Our study revealed that the mean score for nurses’ professional values was moderate to high, indicating a good level of professional commitment. This finding is consistent with those of Du et al. [40], who also reported high levels of professional values among nurses. Adopting and internalizing professional values enhance both nurses’ job satisfaction and the quality of care they provide to patients [41]. Hutagaol et al. [42] suggests that the variation in nursing educational levels and backgrounds may explain these results, as the majority of participants in our study held bachelor’s degree,  followed by those with master’s degree. Additionally, nurses’ work experience and individual factors further contribute to maintaining high professional values among nurses [43].

When assessing various dimensions of professional values, caring emerged as the highest-ranking domain, followed by activism and professionalism. The results align with previous studies, where caring consistently ranks as the top professional value [13, 44]. However, the NICU nurse demonstrated low perceptions of the value of professionalism. Enhancing one’s perception of professionalism is vital as it relates to active engagement with health services, involvement in decision-making processes, and the advancement of the profession [13].

The current study’s results reveal that nurses exhibit a high mean score in caring behavior. Caring behaviors are fundamental to the nursing profession and can enhance self-confidence and job satisfaction, thereby improving patient care standards [13]. In assessing the subscale, NICU nurses ranked the domain of creating a supportive, protective, and corrective environment as the highest, which is critical for patient well-being. This finding is supported by Majait et al. [45] and Basit et al. [13], who underscore the importance of such an environment. However, it contradicts Elsayed et al. [46], who reported “humanism/faith/hope/sensitivity” was highly ranked. Additionally, it differs from Shalaby et al. [14], who found that the highest-ranking category of nurses’ caring behavior was related to “human needs assistance”.

The study’s findings indicate that higher perceptions of care behaviors by nurses are regarded as a positive outcome. This will enhance self-assurance and job satisfaction, ultimately elevating the standard of patient care. However, the study highlights a need for improvement in the area of “existential/ phenomenological/ spiritual forces”, as this was identified as the least significant care behavior in this study. This could be attributed to the challenging nature of comprehending these concepts, as noted by Watson [47]. Understanding these factors requires experience and reflection to provoke thought and deepen one’s understanding of oneself and others. It’s noteworthy that in our study, the majority of nurses were aged less than 30 years old and had less than 5 years of experience in nursing or in NICUs. In contrast to our study, the domain of “expression of positive/ negative feelings” was perceived by nurses as the least important [13].

The Pearson correlation analysis results reveal intriguing insights into the relationship between several characteristics of caring behavior and nurses’ professional values. Firstly, there is a statistically significant positive association between nurses’ total professional values and their caring behavior. This suggests that nurses who uphold their professional values are more likely to exhibit caring behaviors in their practice. Notably, the aspect of creating a supportive/protective/corrective environment shows the strongest correlation among the caring behavior domains. This implies that nurses who prioritize fostering a supportive and protective environment also tend to demonstrate higher levels of professional values. These findings are consistent with those of Kootahi et al. [24] and are confirmed by Arsat et al. [48]. They align with the core principle of nursing, emphasizing the importance of compassionate and comprehensive care environments for optimal patient outcomes [49].

Notably, however, there is no discernible relationship between professional values and human needs support, teaching/learning, or existential/phenomenological/spiritual forces, suggesting that these aspects of caring behavior may be influenced by variables other than professional values. Another explanation could be related to the low sample size in our study, which may have affected the outcomes. The present study’s findings emphasize the intricate association between an individual’s professional values and their demonstration of caring behaviors. The results led to the conclusion that there is indeed a relationship between nurses’ assessment of professional values and their care behaviors. As demonstrated by Basit et al. [13], this underscores the importance of providing ongoing education and training along with fostering a supportive organizational culture to enhance both aspects of nursing practice.

According to the current study, professional values are a significant predictor of caring behavior among NICU nurses. This finding is consistent with previous studies, which have identified a statistically significant positive correlation between professional values and care behaviors [13, 24, 37, 48]. These findings underscore the critical role of professional values in influencing the quality of care provided in NICU settings. Therefore, strengthening professional values among NICU nurses could be beneficial for enhancing caring behaviors and improving patient outcomes.

In conclusion, this study provides valuable insights into the association between NICU nurses’ professional values and caring behaviors. The findings indicated a positive relationship between professional values and caring behaviors, particularly in the domain fostering a “Supportive/ protective/ corrective environment”. Therefore, it’s imperative to enhance nurses’ professional values, whether for professional nurses or nursing students, through continuous education and training. Additionally, nursing students should deeply integrate caring concepts into their education. This approach could contribute to enhanced care quality for a diverse range of patients, especially newborn babies, and their families