Nurses' Caring Behaviors in Swaziland: The Impact of Professional Values, Compassion Fatigue, and Emotional Intelligence

Purpose: Globally, the nursing profession is known for caring, the fundamental component of nursing practice (Karlou, Papathanassoglou, & Patiraki, 2015). In the Kingdom of Swaziland, incidents of poor caring behaviors and unprofessionalism by practicing nurses has been increasingly reported in the press (J. Dlamini, 2015; T. Dlamini, 2014); breaches in confidentiality, physical and emotional abuse of patients and family, and widespread patient neglect may undermine the public’s trust in nurses and tarnish the profession’s reputation. Poor caring behaviors and unprofessionalism were also reported worldwide (Albina, 2016; Kujawski et al., 2015; McMahon et al., 2014; Okafor, Ugwu, & Obi, 2015). Neglect, verbal and physical abuse are some of the deliberate violations of patients’ human rights promulgated by nurses and are associated with poor quality and effectiveness of health-care services (Albina, 2016). Swaziland has a high burden of disease – particularly HIV and tuberculosis – and nurse-patient ratios are high in the hospital settings (Mamba, Dlamini, Mallinson, & Williams, 2013). It is important to identify the factors that contribute to poor nursing caring and unprofessional behaviors.

The first purpose of this mixed-method (Quant + Qual) study was to identify which independent variables (nurses’ professional values emotional intelligence, and professional quality of life) that best predict nurses’ caring behaviors. Professional quality of life measures ‘compassion fatigue’ and ‘compassion satisfaction.’ The second purpose was to develop a grounded theory illuminating the process by which nurses develop a practice guided by professional nursing values. This presentation reports on the quantitative component of the study.

Methods: In the cross-sectional quantitative component of this study, a survey was administered to a purposive sample of professional nurses (N=267) providing direct patient care in the 10 hospitals in the Kingdom of Swaziland. Data collection occurred in July 2017. In addition to a demographics form, the respondents completed the Nursing Professional Values Scale – Revised, the Assessing Emotions Scale, the Professional Quality of Life (ProQOL) scale, and the Caring Behaviors Inventory.

Results: Most of the sample (65%) was female, with an average age of 34 years, and 9 years of experience as a nurse. There were statistically significant relationships (Pearson’s correlation) between nurses’ caring behaviors and nurses’ professional values (r = .494, p < .01), emotional intelligence (r = .423, p < .01), compassion satisfaction (r = .469, p < .01), compassion fatigue (r = -.134, p < .05), and participant’s work experience (r = .162, p < .01). No statistically significant relationship was found between caring behaviors and the participant’s age (r = .087, p = .157). After controlling for gender, years of experience, highest qualification, hospital, and training institutions, the hierarchical multiple regression analysis demonstrated that nurses’ professional values (R² = .417, β = .351, p = .000), emotional intelligence (β = .143, p = .015) and compassion satisfaction (β = .240, p = .000) explained considerable variability in nurses’ caring behaviors. Moderation analysis showed that compassion satisfaction was not a statistically significant moderator of the relationship between nurses’ professional values and caring behaviors (R² = .404, β = .037, p = .468); similarly, compassion satisfaction did not moderate the relationship between emotional intelligence and caring behaviors (R² = .331, β = -.047, p = .383). Compassion fatigue was also not a statistically significant moderator of the relationship between nurses’ professional values and caring behaviors (R² = .353, β = -.019, p = .729), nor was it a statistically significant moderator of the relationship between emotional intelligence and caring behaviors (R² = .287, β = .056, p = .342).

Conclusion: Addressing the unprofessional behaviors by nurses in Swaziland is crucial to improving the quality of care delivered to the Swazi people. Some of the factors influencing nursing caring behaviors are modifiable. These findings provide evidence that nurturing nurses’ professional values, strengthening emotional intelligence, enhancing compassion satisfaction, and minimizing compassion fatigue among practicing nurses may lead to an increase in their caring behaviors. Increasing the nurses’ caring behaviors may promote ethical practices and interactions that further enhance the image of the nursing profession and support healthcare seeking habits of Swazi citizens. The results of this study may guide the development of interventions to cultivate nurses’ caring behaviors; for example, educational curricula and in-service continuing professional development programs may be designed to instill nursing professional values, raise personal awareness, or strengthen skills in emotional intelligence.

Future research could examine the impact of related concepts (e.g. personal grief, workplace stress, or personal values) that may have a significant impact upon the nurses’ caring behaviors. Also, researchers could test personal, group, or community-level interventions designed to impact the modifiable variables that may lead to increased caring behaviors among practicing nurses.