SPIRITUAL AND EMOTIONAL SUPPORT

Effect of spiritual intelligence, emotional intelligence, psychological

ownership and burnout on caring behaviour of nurses:
a cross-sectional study
Devinder Kaur, Murali Sambasivan and Naresh Kumar

Aims and objectives. To propose a model of prediction of caring behaviour among nurses that includes spiritual intelligence,
emotional intelligence, psychological ownership and burnout.
Background. Caring behaviour of nurses contributes to the patients’ satisfaction, well-being and subsequently to the perfor-
mance of the healthcare organisations. This behaviour is influenced by physiological, psychological, sociocultural, develop-
mental and spiritual factors.
Design. A cross-sectional survey was used, and data were analysed using descriptive statistics and structural equation model-
ling.
Methods. Data were collected between July–August 2011. A sample of 550 nurses in practice from seven public hospitals in
and around Kuala Lumpur (Malaysia) completed the questionnaire that captured five constructs. Besides nurses, 348 patients
from seven hospitals participated in the study and recorded their overall satisfaction with the hospital and the services
provided by the nurses. Data were analysed using structural equation modelling (SEM).
Results. The key findings are: (1) spiritual intelligence influences emotional intelligence and psychological ownership, (2)
emotional intelligence influences psychological ownership, burnout and caring behaviour of nurses, (3) psychological owner-
ship influences burnout and caring behaviour of nurses, (4) burnout influences caring behaviour of nurses, (5) psychological
ownership mediates the relationship between spiritual intelligence and caring behaviour and between emotional intelligence
and caring behaviour of nurses and (6) burnout mediates the relationship between spiritual intelligence and caring behaviour
and between psychological ownership and caring behaviour of nurses.
Conclusions. Identifying the factors that affect caring behaviour of nurses is critical to improving the quality of patient care.
Spiritual intelligence, emotional intelligence, psychological ownership and burnout of nurses play a significant role in effect-
ing caring behaviour of nurses.
Relevance to clinical practice. Healthcare providers must consider the relationships between these factors in their continuing
care and incorporation of these in the nursing curricula and training.

Key words: burnout, caring behaviour, emotional intelligence, nurses, psychological ownership, public hospital, spiritual
intelligence

Accepted for publication: 3 April 2013

Authors: Devinder Kaur, PhD, Senior Lecturer, Asia Pacific Univer-
sity of Technology & Innovation (A.P.U), Bukit Jalil; Murali
Sambasivan, PhD, Professor, Graduate School of Management,
Universiti Putra Malaysia, Serdang, Global Entrepreneurship
Research and Innovation Centre (GERIC), Universiti Malaysia
Kelantan, Putrajaya and Taylor’s Business School, Taylor’s
University, Subang Jaya; Naresh Kumar, PhD, Associate Professor,
Graduate School of Management, Universiti Putra Malaysia,
Serdang and Global Entrepreneurship Research and Innovation
Centre (GERIC), Universiti Malaysia Kelantan, Putrajaya, Malaysia.
Correspondence: Murali Sambasivan, Professor, GERIC, UMK, Lot
2B, Second Floor, Jalan 2/1 Diplomatik, Presint Diplomatik, 62050
Putrajaya, Malaysia. Telephone: +60 12 9350065.
E-mail: sambasivan@hotmail.com

© 2013 John Wiley & Sons Ltd

3192 Journal of Clinical Nursing, 22, 3192–3202, doi: 10.1111/jocn.12386
Spiritual and emotional support
Introduction
Quality health care is of crucial importance to healthcare
consumers, and healthcare providers across the world are
assessed based on their standards of care and service
excellence (Anthony et al. 2004, Ford et al. 2006). Previ-
ous literature has pointed out that nurse caring behaviour
contributes to healthcare organisations in three distinct
ways: (1) increasing the satisfaction level of patients, (2)
enhancing patients’ well-being and (3) improving financial
performance (Tzeng et al. 2002, Al-Mailan 2005). How-
ever, based on the review of literature, the factors effect-
ing caring behaviour have not been identified and
investigated adequately (Leiter et al. 1998, Rego et al.
2010), and this research addresses four such factors
(constructs): spiritual intelligence (SI), emotional intelli-
gence (EI), psychological ownership (PO) and burnout
(BO). Of these, effects of SI and PO on caring behaviour
are new in the nursing literature. In this study, caring
behaviour refers to physical and affective aspect of care
shown by nurses that provides comfort, both physical
and emotional, to the patients (Rego et al. 2010). The
following four paragraphs outline the importance of
the four constructs (SI, EI, PO and BO) on the caring
behaviour of nurses.
Pellebon and Anderson (1999) have asserted that spiritu-
ality has the ‘most notable impact on an individual’s atti-
tudes, behaviors and decision-making process’ (p. 229). The
concept of spirituality is important and forms the basis of
nursing actions (Van Leeuwen & Cusveller 2004). There-
fore, including spirituality into nursing care leads to supe-
rior performance and excellent quality care to patients
(Donley 1991). Very few empirical studies have provided
supporting evidence linking spirituality and caring behav-
iour of nurses, and to our knowledge, there are no empiri-
cal studies linking SI and caring behaviour of nurses.
Managing emotions is an important skill for nurses
(Freshwater & Stickley 2004, McQueen 2004). Emotional
intelligence (EI) facilitates the management of emotion in
intrapersonal and interpersonal dynamics that enables the
ability to think and function in a constructive and
rational way (Akerjordet & Severinsson 2007). Sumner
and Townsend-Rocchiccioli (2003) have asserted that an
effective management of one’s own and others’ emotions
is crucial to providing quality patient care. Therefore, EI
can have a positive impact on the caring behaviour of
nurses. Despite the theoretical support, empirical studies
that link the concept of EI and caring behaviour are rare
(Akerjordet & Severinsson 2007, Kooker et al. 2007,
Rego et al. 2010).
© 2013 John Wiley & Sons Ltd
Journal of Clinical Nursing, 22, 3192–3202
Factors affecting caring behaviour of nurses
Stress is an inherent and widely accepted part of the
nursing profession, and a prolonged exposure to stress
leads to burnout (BO) which in turn affects the perfor-
mance of nurses. BO has been linked to decreased motiva-
tion, reduced effectiveness and increased negative attitudes
and behaviour at work (Maslach et al. 2001, Laschinger &
Leiter 2006). However, empirical research that examines
the link between BO and caring behaviour is limited (Leiter
et al. 1998).
Literature provides evidence that individuals may develop
feelings of ownership towards their organisation, jobs,
inventions, work space and work tools (Mayhew et al.
2007). Beliefs of ownership can have a positive effect on
employee’s work attitudes and work behaviours (Mayhew
et al. 2007, Md-Sidin et al. 2010). However, no empirical
research so far has linked the concept of PO and caring
behaviour of nurses.
Background
Framework of this research is influenced mainly by the
Neuman’s System Model (Neuman 1995). Neuman’s
System Model describes the wellness of the client or the
client system in relation to environmental stress and
reaction to stress (Neuman 1995). In other words, the
Neuman’s System Model provides a comprehensive expla-
nation of an individual’s adaptation to environmental
stressors. She has emphasised the combination of spirit,
mind and body in adapting to the environment to retain,
attain and maintain wellness and has identified five
variables that affect the performance of nurses: physiologi-
cal, psychological, sociocultural, developmental and
spiritual.
In this study, the nurse is identified as the client system
and further description of the client system identifies the
basic structure or core as the hospital staff nurses’ caring
behaviour. Caring is influenced by the ability of the hospital
nurses to provide quality care to patients while managing
stress. The basic core may be repeatedly bombarded by
stressors at work and the environment. The stressors may
try to break through the lines of defence and resistance and
cause damage to the core that is the nurses’ caring behav-
iours. The term ‘defence’ in this context includes usual well-
ness of nurses and external protection from individual,
family, group or community. The term ‘resistance’ refers to
protective mechanisms that can help nurses return to usual
wellness. The lines of resistance and defence must protect
the nurse, and the quality of the nurses’ caring behaviour
will depend on the strength of the lines of defence and resis-
tance. For example, if the lines of resistance in nurses are
3193
D Kaur et al.
inadequate, burnout may occur and further affect the core
resulting in decrease in the level of caring behaviours among
nurses.
Neuman (1995) has proposed that the physiological,
psychological, sociocultural, developmental and spiritual
variables determine the strength of protection provided by
the lines of defence and resistance. Thus, when consider-
ing the interaction of burnout with the ability to give con-
scientious care, an individual may rely on all or any of
the five variables to strengthen the flexible and normal line
of defence. In doing so, the nurse will be able to prevent
the penetration of both the lines of defence and protect
the basic core. The interaction between these five variables
can have a direct impact on the caring behaviour of
nurses (Deshpande & Joseph 2009). This study addresses
the effect of SI (spiritual), EI (psychological), BO (physio-
logical) and PO (psychological) on the caring behaviour of
nurses. The conceptual framework used in this study is
given in Fig. 1.
EI and caring behaviour
Nurses who recognise their own and patients’ emotions are
more likely to manage them and show better care towards
patients (Kerfoot 1996, McQueen 2004). According to
Rego et al. (2010), caring is the essence of nursing and
nurses must (1) be respectful and responsive to individual
patient preferences, values and needs and (2) provide
patients with emotional support (p. 1419). To date, only a
study by Rego et al. (2010) has empirically validated the
relationship between EI and caring behaviour of nurses.
Based on these arguments, we hypothesise:
H1: There is a positive relationship between EI and nurse
caring behaviours.
Emotional Burnout
(-ve) (-ve)
(EI) (BO)
(+ve) (+ve)
Caring
(+ve) (-ve) (-ve) (CB)
(+ve) (+ve)
Spiritual (SI) Ownership
(+ve) (PO)
Figure 1 A theoretical framework (with hypothesised relationships)
to study caring behaviour of nurses. SI, spiritual intelligence; EI,
emotional intelligence; PO, psychological ownership; BO, burnout;
CB, caring behaviour.
3194
SI and caring behaviour
Spirituality and nursing have been linked since the origins
of the profession. Holistic care is the balance between
body, mind and spirit, and therefore, spiritual dimension
plays an important role in nursing (Neuman 1995, Naray-
anasamy 2006). Many authors have recommended that
spirituality be included in the education and training of nurses
to provide holistic nursing care (Narayansamy & Owens 2001,
Yang & Mao 2007). Spirituality and SI are strongly linked
(Emmons 2000). Based on this link, we hypothesise:
H2: There is a positive relationship between SI and nurse
caring behaviours.
PO and caring behaviour
Pierce et al. (2003) have asserted that psychological own-
ership promotes a sense of responsibility that includes the
feelings of being protective and compassionate for the
target (target refers to the organisation and/or job). In
short, PO creates a ‘sense of responsibility that influences
behavior’ (Van Dyne & Pierce 2004, p. 445). Previous
research has suggested that employees with high PO are
more likely to display positive in-role (refers to perfor-
mance in the job) (Md-Sidin et al. 2010, Bernhard &
O’Driscoll 2011) and extra-role behaviours (refers to citi-
zenship behaviours) (Pierce et al. 2001, Mayhew et al.
2007, Bernhard & O’Driscoll 2011). Based on the above
arguments, we posit:
H3: There is a positive relationship between PO and
nurse caring behaviours.
BO and caring behaviour
An individual suffering from BO begins to distance from cli-
ents because he/she has exhausted useful coping mechanisms.
Maslach (1979) describes distancing as unhealthy for both
client and caregiver, because it negatively influences caring
behaviour. Based on the above arguments, we postulate:
H4: There is a negative relationship between BO and
nurse caring behaviours.
SI and EI
Theoretical propositions have pointed out SI as core ability,
a general factor that penetrates into and guides other abili-
ties (Fry 2003, Ronel & Gan 2008). Specifically, some
authors have asserted that SI influences EI (Zohar &
Marshall 2000, Hosseini et al. 2010). Based on the above
arguments, we hypothesise:
© 2013 John Wiley & Sons Ltd
Journal of Clinical Nursing, 22, 3192–3202
Spiritual and emotional support
H5: There is a positive relationship between SI and EI of
nurses.
SI and PO
Control has been suggested to be a critical determinant of
feelings of ownership (Furby 1978). Theoretical proposi-
tions and empirical research have positively linked spiritual-
ity to internal locus of control (Jackson & Coursey 1988,
Fiori et al. 2004). Psychological ownership is similar to
having an internal locus of control because it represents an
internally based drive to effect circumstances. Based on the
above arguments, we postulate:
H6: There is a positive relationship between SI and PO
of nurses.
SI and BO
Researchers have argued that higher levels of spirituality
result in lower levels of BO among individuals (MacDonald
& Friedman 2002). Few studies have shown that dimen-
sions of spirituality can buffer the negative effects of BO
(Alexander et al. 1989, King & DeCicco 2009). Based on
the above arguments, we posit:
H7: There is a negative relationship between SI and BO
of nurses.
EI and PO
Theoretical propositions and empirical research have posi-
tively linked EI to internal locus of control (Broedling 1975,
Singh 2006). Thus, high levels of EI enable an employee to
have personal control. Emotional management refers to the
ability to regulate and control emotions and behaviours
according to situational appropriateness. Therefore, manag-
ing own emotions enables an employee to have personal
control, which can be regarded as a proxy for control over
the employee’s work environment and contribute to the
feelings of ownership. One of the main routes to PO is per-
ceived control as it satisfies the human motive of efficacy
(Pierce et al. 2004). Therefore, we hypothesise:
H8: There is a positive relationship between EI and PO
of nurses.
EI and BO
Several researchers have studied the relationship between EI
and BO (Chan 2006, Brackett et al. 2010). The develop-
ment of BO syndrome may depend on the interpretation of
emotional information. Therefore, we postulate:
© 2013 John Wiley & Sons Ltd
Journal of Clinical Nursing, 22, 3192–3202
Factors affecting caring behaviour of nurses
H9: There is a negative relationship between EI and BO
of nurses.
PO and BO
As people become emotionally depleted, they cope by
cutting back on their involvement with others. This deper-
sonalisation effect leads to various negative attitude and
behaviours. According to researchers, PO leads to positive
work attitudes and behaviours (Van Dyne & Pierce 2004,
Mayhew et al. 2007). If nurses develop high levels of PO
towards their jobs, depersonalisation effect can be reduced
to a great extent and this in turn can reduce the BO of
nurses. Based on these arguments, we postulate:
H10: There is a negative relationship between PO and BO
of nurses.
Mediating role of BO
There are only a few studies that have examined the medi-
ating role of BO between individual differences and work
outcomes. Huang et al. (2010) have proposed that BO
mediates the relationship between emotional intelligence
and work performance. In the earlier sections, we have
espoused the following relationships: between SI, EI, PO
and BO; between BO and caring behaviour of nurses; and
between SI, EI, PO and caring behaviour of nurses. Based
on these arguments, we posit:
H11a: BO mediates the relationship between SI and
nurse caring behaviours.
H11b: BO mediates the relationship between EI and
nurse caring behaviours.
H11c: BO mediates the relationship between PO and
nurse caring behaviours.
Mediating role of PO
There are no studies linking PO and nurses. In earlier
sections, we have espoused the following relationships:
between SI, EI and PO; between PO and caring behaviour
of nurses; and between SI, EI and caring behaviour of
nurses. Based on these arguments, we posit:
H12a: PO mediates the relationship between SI and nurse
caring behaviours.
H12b: PO mediates the relationship between EI and
nurse caring behaviours.
Methods
The aim of the study is to propose a model of prediction of
caring behaviour among nurses that includes SI (spiritual
3195
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intelligence), EI (emotional intelligence), PO (psychological Table 1 Demographic characteristics of the nurses (n = 448)
ownership) and BO (burnout). A cross-sectional study design Variable n %
was used. A sample of 550 nurses in practice from seven
public hospitals in and around Kuala Lumpur (Malaysia) Gender
Male 10 2
23
completed the questionnaire that captured five constructs.
Female 438 97
77
Besides nurses, 348 patients from seven hospitals participated Age (years)
in the study and recorded their overall satisfaction with the 20–29 195 43
53
hospital and the services provided by the nurses. The research 30–39 136 30
36
was conducted between July 2011–August 2011. 40–49 62 13
84
50–59 55 12
27
Ethnic group
Participants Malay 404 90
18
Chinese 11 2
45
The study was conducted in seven large public hospitals in Indian 27 6
03
and around the vicinity of Kuala Lumpur, capital of Malay- Others 6 1
34
sia. These hospitals have a total capacity of 6194 beds, and Marital status
Single 112 25
00
7446 nurses are employed in these hospitals. A sample of
Married 333 74
33
550 nurses was selected at random. The nurses were from Divorced 1 0
22
the following departments: general surgical, general medi- Widowed 2 0
45
cal, paediatrics, obstetrics and gynaecology and orthopae- Years of work experience
dics. Besides nurses, 348 patients from seven hospitals <1 62 13
85
2–5 110 24
55
participated in the study and recorded their overall satisfac-
6–10 87 19
42
tion with the hospital and the services provided by the 11–15 81 18
08
nurses. Responses from the patients helped validate the 16–20 29 6
47
caring behaviour of nurses. The demographic characteristics 21> 79 17
63
of the respondents are given Table 1. Qualification
Certificate 51 11
38
Diploma 364 81
25
Ethical considerations Bachelor’s 30 6
70
Master’s 3 0
67
Permission to conduct research in these seven hospitals was Department
obtained from the Ethics and Research Committee of Min- General medical 117 26
12
istry of Health Malaysia. The permission helped gain access General surgical 118 26
34
Paediatrics 80 17
86
to seven hospitals. The questionnaires were distributed
O&G 68 15
18
through the chief matron at each hospital. The nurses were Orthopaedic 65 14
50
given the option to refuse participation. It was made clear
that returning the questionnaire after completion was
considered as informed consent for participation in the
study. study. Section C captured BO, and the scale with 22 items
developed by Maslach et al. (1996) [Maslach Burnout
Inventory–Human Service Survey (MBI-HSS)] was adopted
Instrument
in this research. Section D captured PO, and the scale with
The questionnaire designed for this study consisted of six six items developed by Pierce et al. (2004) was adopted in
sections. The questionnaire items were made available in this research. Section E captured caring behaviours of
English and Bahasa Malaysia (BM – national language of nurses, and the scale with 24 items developed by Wu et al.
Malaysia). The translation was checked by language (2006) was adopted in this research. Section F captured the
experts. Section A captured EI, and the scale with 33 items demographic data. The patient satisfaction with overall
developed by Schutte et al. (1998) [Schutte Self-Report nursing care was measured to validate the findings on the
Emotional Intelligence Test (SSEIT)] was adopted in this nurses’ own perception of their caring behaviours. This
study. Section B captured SI, and the scale with 24 items scale contained three items and was adopted from the study
developed by King and DeCicco (2009) [Spiritual Intelli- by Otani et al. (2010). Written permissions were obtained
gence Self-Report Inventory (SISRI)] was adopted in this from all the authors before using their scales.

© 2013 John Wiley & Sons Ltd

3196 Journal of Clinical Nursing, 22, 3192–3202
Spiritual and emotional support Factors affecting caring behaviour of nurses

Data analysis with the help of language experts from Universiti Putra
Malaysia. The translated version was then compared with
Of the total 550 questionnaires sent, 487 were returned
the original version to ensure validity of the instrument. An
(response rate = 88
5%). Thirty-nine questionnaires were
internal consistency reliability test was performed on the
not filled properly, and finally, 448 were deemed usable.
five constructs using Cronbach’s alpha values, and the
Reliabilities and validities of various constructs are given in
values were between 0
75–0
92. Besides, validity test was
Table 2. Descriptive statistics such as mean and standard
performed using confirmatory factor analysis (CFA). The
deviation of constructs and correlation between constructs
convergent and discriminant validities were checked using
were computed using SPSS, version 18, and the values are
the guidelines prescribed by Hair et al. (2009): (1) compos-
given in Table 3. The confirmatory factor analysis (CFA)
ite reliability (CR) of all constructs was > 0
7 except burn-
and testing of hypotheses were performed using structural
out, (2) average variance extracted (AVE) of all constructs
equation modelling (SEM) software, LISREL, student version
was > 0
5 and (3) AVE of each construct was greater than
8.52 (Scientific Software International, Inc., Skokie, IL,
the squared correlation of that construct with other con-
USA). Mediation analyses of BO and PO were performed
structs.
based on the procedure suggested by Baron and Kenny
(1986) and Mathieu and Taylor (2006).

Reliability and validity
The questionnaire was prepared in English and Bahasa
Malaysia (BM). The BM version was translated to English
Results
Based on the mean values of the constructs, characteristics of
Malaysian nurses in public hospitals are: majority of nurses
are women (about 98%), average age of nurses is 34
5 years,

Table 2 Results of reliability and confirmatory factor analysis (CFA)

Cronbach’s
No. of items/ alpha
Variable dimensions (n = 448) Validity (CFA)*

Emotional intelligence 33/4 0
89 v2 = 0
60 (p-value = 0
74), RMSEA = 0
015, RMR = 0
015, GFI = 0
99,
NFI = 0
99, CFI = 0
99
Spiritual intelligence 24/4 0
92 v2 = 1
17 (p-value = 0
28), RMSEA = 0
019, RMR = 0
0051, GFI = 0
99,
NFI = 0
99, CFI = 0
99
Burnout 22/3 0
75 v2 = 0
0058 (p-value = 0
94), RMSEA = 0
019, RMR = 0
0051, GFI = 0
99,
NFI = 0
99, CFI = 0
99
Psychological ownership 6/1 0
88 v2 = 1
12 (p-value = 0
772), RMSEA = 0
005, RMR = 0
0062, GFI = 0
99,
NFI = 0
99, CFI = 0
99
Caring behaviours 24/4 0
92 v2 = 8
11 (p-value = 0
017), RMSEA = 0
013, RMR = 0
013, GFI = 0
98,
NFI = 0
98, CFI = 0
98

v2, chi-square value; RMSEA, root mean square error approximation (must be < 0
08); RMR, root mean square residual (must be < 0
08);
GFI, goodness-of-fit index (must be > 0
9); NFI, normed fit index (must be > 0
9); CFI, comparative fit index (must be > 0
9).
*CFA was performed using LISREL 8.52 student version. Analysis was performed at the construct-dimension level.

Table 3 Mean, standard deviation and correlation between constructs

Variable Mean SD EI SI BO PO CB CR AVE

EI 3
85 0
06 1
00 0
28* 0
063 0
084 0
1 0
84 0
57

SI 3
52 0
10 0
525** 1
00 0
032 0
056 0
059 0
91 0
72
BO 2
15 0
09 0
251** 0
179** 1
00 0
083 0
11 0
62 0
52
PO 4
24 0
09 0
289** 0
236** 0
288** 1
00 0
127 0
79 0
55
CB 4
24 0
11 0
315** 0
243** 0
333** 0
357** 1
00 0
91 0
72

EI, emotional intelligence; SI, spiritual intelligence; BO, burnout; PO, psychological ownership; CB, caring behaviour; CR, composite reli-
ability; AVE, average variance extracted.
*Values above the diagonal are squared correlations.
**Significant at 0
01 level.

© 2013 John Wiley & Sons Ltd

Journal of Clinical Nursing, 22, 3192–3202 3197
D Kaur et al.
average work experience is 10 years, nurses have moderate
SI (mean = 3
52) and EI scores (mean = 3
85), low BO score
(mean = 2
15), high PO (mean = 4
24) and caring behaviour
scores (mean = 4
24). The measure on patient satisfaction
indicates: (1) 90% of patients are satisfied with the care pro-
vided by the nurses, (2) 80% are willing to return if needed
and (3) 78% are willing to recommend public hospitals to
others. The responses from the patients are in line with the
nurses’ own perception of their caring behaviour.
The significant relationships between various constructs
are shown in Fig. 2. Based on the results, many interesting
findings are in order. First, SI has a strong positive relation-
ship with EI (r = 0
53, p = 0
000). The result of this study
is consistent with the theoretical proposition that SI is a
general factor of intelligence underlying any other factor of
intelligence and therefore has the capability to influence EI
(Zohar & Marshall 2000, Ronel & Gan 2008). Second,
individuals (nurses) with higher levels of SI tend to have
higher levels of PO towards their jobs (r = 0
12,
p = 0
016). According to Pierce and Rodgers (2004), there
are three factors that facilitate the development of PO: (1)
personal control over the target, (2) better knowledge about
the target and (3) investment of self to the target. SI
through its four components (critical existential thinking,
personal meaning production, transcendental awareness
and conscious state expansion) (King & DeCicco 2009)
enable individuals to have control, develop intimate contact
and invest self to the object or target (Fiori et al. 2004). In
this study, the target or object is the job of nursing. Third,
Mediator Mediator
Emotional –0·18(0·000) Burnout
(BO)
(EI) 0·19(0·000) –0·22(0·000)
0·53(0·000) 0·23(0·000) –0·24(0·000) Caring
(CB)
Spiritual Ownership
0·12(0·016) (PO) 0·24(0·000)
(SI)
Mediator
Figure 2 Factors affecting caring behaviour of nurses. All relation-
ships are significant – structural model run at the construct level;
numbers given in the parentheses are p-values. SI, spiritual intelli-
gence; EI, emotional intelligence; PO, psychological ownership;
BO, burnout; CB, caring behaviour. Model fit indices: v2 = 2
31
(p-value = 0
31), RMSEA = 0
019, RMR = 0
015, CFI = 0
99,
GFI = 0
99, NFI = 0
99 (Analysis software – LISREL, 8.52 student
version).
3198
individuals (nurses) with higher levels of EI have higher
levels of PO towards their jobs (r = 0
23, p = 0
000). EI
through its four components (perception of emotion, man-
aging own emotion, managing others’ emotion and utilisa-
tion of emotion) (Ciarrochi et al. 2001) enables nurses to
have control over their jobs (Singh 2006). Fourth, nurses
with high levels of EI exhibit higher levels of caring behav-
iour (r = 0
19, p = 0
000). The results of this study are con-
sistent with the findings by Rego et al. (2010), and they
have studied the effect of EI on the caring behaviour of
nurses in Portugal. EI plays an important role in forging
successful human relationships (McQueen 2004). Nurses
who cannot manage their emotions and understand their
patients’ emotions cannot provide high-quality care. Fifth,
nurses with higher levels of EI suffer lesser levels of BO
(r = 0
18, p = 0
000). Chan (2006) has studied the rela-
tionship between EI and BO using a sample of Chinese sec-
ondary school teachers in Hong Kong and has found that
EI is negatively associated with BO. Our study supports the
notion that people-oriented jobs like nursing require high
levels of EI to experience low levels of BO. Sixth, nurses
with higher levels of PO experience lesser levels of BO
(r = 0
24, p = 0
000). Among the different healthcare
providers, nurses are considered at high risk of work-
related stress and are particularly susceptible to BO (Piko
2006). Researchers have argued that PO leads to positive
work attitudes and behaviours (Van Dyne & Pierce 2004,
Mayhew et al. 2007, Md-Sidin et al. 2010), and these can
lead to lesser levels of BO through reduction in the levels of
emotional exhaustion. Seventh, nurses who experience
higher levels of BO exhibit poor caring behaviour
(r = 0
22, p = 0
000). There is limited empirical evidence
on the effect of BO on caring behaviours of nurses, and the
results of our study are consistent with the findings of ear-
lier studies (Leiter et al. 1998). Eighth, nurses with higher
levels of PO exhibit better caring behaviour (r = 0
24,
p = 0
000). Many previous studies have provided adequate
empirical evidence to show that PO influences work-related
behaviours (Van Dyne & Pierce 2004, O’Driscoll et al.
2006, Bernhard & O’Driscoll 2011). Even though there are
no previous studies that link PO and caring behaviour of
nurses, we believe that, from the theoretical foundations of
PO, there is enough evidence to support our conclusions.
Ninth, PO mediates the relationship between (1) EI and
caring behaviour (Sobel’s test: t-value = 3
34, p-value =
0
000) and (2) SI and caring behaviour (Sobel’s test:
t-value = 2
03, p-value = 0
043). This result is significant
because it explains how PO plays a role in explaining the
influence of EI and SI on caring behaviour of nurses. EI
and SI of nurses enhance the feeling of influence and con-
© 2013 John Wiley & Sons Ltd
Journal of Clinical Nursing, 22, 3192–3202
Spiritual and emotional support
trol over the job. This positive feeling towards the job
increases PO. Based on the theoretical underpinnings, PO
enhances the caring behaviour of nurses. As indicated
earlier, this study is first of its kind in nursing literature to
study the relationships between EI, SI, PO and caring
behaviour of nurses. Tenth, BO mediates the relationship
between EI, PO and caring behaviour. Specifically, BO
mediates the relationship between EI and caring behaviour
(Sobel’s test: t-value = 3
01, p-value = 0
000) and (2) PO
and caring behaviour (Sobel’s test: t-value = 3
5,
p-value = 0
000). The mediating effect of BO has been
analysed in various studies (Maslach et al. 2001, Leiter &
Maslach 2009), and specifically, Huang et al. (2010) have
studied the mediating role of BO between EI and work per-
formance of employees in a call centre in China. We argue
that EI and PO help reduce the BO of nurses by decreasing
their feelings of depersonalisation. This effect in turn
improves the caring behaviour of nurses.
Discussion
As indicated earlier, a few researchers have pointed out SI
as core ability, a general factor that penetrates into and
guides other abilities (Fry 2003, Ronel & Gan 2008). Our
research has clearly established this fact. Based on the
results, key findings are: (1) SI influences EI and PO, (2) EI
influences PO, BO and caring behaviour of nurses, (3) PO
influences BO and caring behaviour of nurses and (4) BO
influences caring behaviour of nurses. What are the implica-
tions of these findings? SI is very fundamental to nursing
profession. It is important to note that spirituality and reli-
giousness are distinctly different but significantly correlated
(Moberg 2005, Yang & Wu 2009). It is plausible for a
nonreligious person to have a higher level of SI. SI centres
on inner resources of a person, and it manifests in various
ways such as positive self-concepts, unselfish giving, higher
moral character and personal transcendence (Fehring et al.
1987). Therefore, spiritual well-being of nurses is critical
for quality health care. Can spirituality be developed and SI
improved? The importance of spirituality in nursing has
resulted in the emergence of a body of literature that dis-
cusses the role of education in meeting the spiritual needs
of first the nurses and then their care recipients (Narayanas-
amy 2006, Baldacchino 2008). The curriculum designed in
training and educating nurses must include spirituality.
Baldacchino (2008) suggests using self-reflection and case
studies in nursing education to enable nursing students to
link spirituality and the practice of care. Narayanasamy
(2006) has developed a model for spiritual care education
and training of nurses.
© 2013 John Wiley & Sons Ltd
Journal of Clinical Nursing, 22, 3192–3202
Factors affecting caring behaviour of nurses
Our research has revealed the two-stage process by which
SI may affect nurses’ caring behaviours. First, SI by virtue
of its role as an encompassing guide influences EI and PO
of nurses. Second, EI and PO, in turn, reduce the effects of
BO and influence the caring behaviour of nurses. Research
has shown that people with high EI understand their own
feelings and the feelings of others, know how to manage
themselves and deal successfully with others and respond
effectively to work demands (Dulewicz & Higgs 2003).
Akerjordet and Severinsson (2007) have asserted that EI
has significant implications on nurses’ quality of work in
health care. The results of our study validate this assertion.
EI, in addition to improving the caring behaviour, helps
nurses reduce the effects of BO and increase their feelings
of ownership (PO) towards their jobs. According to Fresh-
water and Stickley (2004), nursing education that fails to
acknowledge the value of emotions fails to inform students
on the importance of human relations and undermines the
core skill of nursing practice. Thus, EI needs to be effec-
tively integrated in the nursing curricula.
The concept of PO in nursing literature is fairly new.
Many studies have established links between PO and work
environment factors such as autonomy, participation in
decision-making, technology routinisation at work, leader-
ship styles and perceptions of justice (O’Driscoll et al.
2006, Bernhard & O’Driscoll 2011, Sieger et al. 2011).
Managers of hospitals must ensure that an environment
conducive for nurses to experience the feelings of owner-
ship is provided. For example, the hospital authorities can
provide higher autonomy to nurses and allow them to par-
ticipate in making decisions that affect them. The feelings
of ownership towards their jobs help nurses reduce the
effects of BO and improve their caring behaviours.
This study has a few implications to the theory and prac-
tice of nursing. First, the importance of role of SI in nursing
literature has been revealed. Specifically, the fundamental
question answered in this study is: As an antecedent, how
does SI affect the caring behaviour of nurses? Second, this
study has revealed the process by which SI affects the
caring behaviour. Specifically, the roles of EI and PO have
been explicated. Third, through this study, we have
introduced PO as a valid and viable construct into the nurs-
ing literature. Fourth, much of the literature related to EI
still exists outside nursing, and recently, EI research is gain-
ing momentum within the nursing arena (Freshwater &
Stickley 2004, Kooker et al. 2007). In this research, we
have expanded the role of EI by studying its effect on PO
and BO. Fifth, the mediating roles of BO and PO between
SI, EI and caring behaviour have been explored in this
research. Sixth, this study makes recommendations about
3199
D Kaur et al.

the changes that are needed in the nursing curricula and the
work environment.
Even though the framework in this study has been vali-
dated in the context of Malaysia, we believe that the find-
ings can be applied to any other country. The constructs
used in this research (SI, EI, PO, BO and caring behaviour)
are not country specific, and they capture the essential
ingredients of the nursing profession in any part of the
world. For example, a study linking EI and caring behav-
iour of nurses has been conducted in Portugal (Rego et al.
2010); studies linking spirituality and caring behaviour of
nurses have been conducted in the UK and Taiwan
(Narayansamy & Owens 2001, Yang & Mao 2007).
There are a few limitations of this study. First, the
study was conducted in seven large public hospitals in and
around Kuala Lumpur, which is the largest city in Malay-
sia. We did not include private hospitals and other public
hospitals in Malaysia, and therefore, the results might not
be completely generalisable. Second, we were unable to
measure the patients’ perception of nurses’ caring behav-
iours due to the difficulty in matching each patient with
each of the nurses. Therefore, we measured the nurses’
perceptions of their own caring behaviours. However, we
conducted a separate survey among the patients admitted
in the wards to investigate patient’s satisfaction with the
overall nursing care. Third, the data were collected from
nurses within five major departments. There might be
nurses from other departments that were left out in the
study.
This research has demonstrated the roles of SI, EI and
PO in influencing the caring behaviours of nurses in Malay-
sia. Specifically, the following effects have been revealed:
(1) SI as a key guiding construct, (2) SI’s positive influence
on EI and PO, (3) EI’s positive effect on caring behaviour
and PO and EI’s negative effect on BO, (4) PO’s positive
effect on caring behaviour and PO’s negative effect on BO
and (5) BO’s negative effect on caring behaviour. Future
research is required in different countries to validate the
results.
Relevance to clinical practice
Professional healthcare workers and administrators must
pay greater attention to the relationships between the soft
factors addressed in this research as these are critical to
quality of health care provided by nurses. Nursing curricula
and training of nurses must include these factors.
Acknowledgements
The authors thank the nurses and patients who participated
in the study. The authors also thank the Ministry of Health
for giving permission to conduct the study and the research-
ers who shared their research instruments.
Disclosure
The authors have confirmed that all authors meet the ICMJE
criteria for authorship credit (www.icmje.org/ethical_
1author.html), as follows: (1) substantial contributions to
conception and design of or acquisition of data or analysis
and interpretation of data, (2) drafting the article or revising
it critically for important intellectual content and (3) final
approval of the version to be published.
Conflict of interest
None declared.

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