Psychiatric Nurses' Compassion Fatigue, Moral Commitment, Workplace Civility, and Missed Nursing Care: The Mediating Role of Practice Environment

Abstract

To the best of our knowledge, this study was the first to explore the moral commitment and workplace civility of psychiatric nurses working in a Middle Eastern country, as well as the mediating role of the practice environment in the associations between compassion fatigue, moral commitment, workplace civility, and missed nursing care. This cross-sectional and correlational study consecutively recruited psychiatric nurses (n = 207) from three government-owned mental health centers in Saudi Arabia. Five standardised scales were used to collect data from June to November 2024. Covariance-based structural equation modelling was used for data analyses. Psychiatric nurses' moral commitment had a direct, negative, and moderate influence on compassion fatigue (β = −0.24, p = 0.013), practice environment (β = −0.21, p = 0.007), and missed nursing care (β = −0.20, p = 0.008). Compassion fatigue had a direct, positive effect on the practice environment (β = 0.14, p = 0.033) but a negative, direct influence on missed nursing care (β = −0.28, p = 0.003). The practice environment directly and positively influenced missed nursing care (β = 0.16, p = 0.015). Path analyses indicated that moral commitment (β = −0.04, p = 0.027) and compassion fatigue (β = 0.02, p = 0.015) had statistically significant indirect effects on missed nursing care through the mediation of practice environment. Nurse leaders and healthcare institutions are responsible for creating an efficient practice environment for psychiatric nurses, strengthening their moral commitment while effectively managing their compassion fatigue and minimising missed nursing care.