Nursing Presence and Quality of Care: A Cross-Sectional Study of Hospitalized Patients in Iran

Abstract

Introduction

Nursing presence, a critical component of patient-centered care, is intrinsically linked to the quality of healthcare services and patient satisfaction.

Objective

This cross-sectional study aimed to investigate the relationship between nursing presence and the perceived quality of nursing care among hospitalized patients in teaching hospitals in Kermanshah, western Iran.

Methods

A descriptive-analytical cross-sectional study was conducted involving 347 inpatients at teaching hospitals in Kermanshah, Iran. Participants were selected using a proportional quota sampling design to ensure the sample reflected the distribution of patients across different hospital units, with convenience sampling used to recruit participants within each quota. Data were collected using demographic forms and validated questionnaires: the Nursing Presence Scale (PONS) and the Quality Patient Care Scale (QUALPAC). Statistical analysis included descriptive statistics, Pearson and Spearman correlation tests, the Kolmogorov–Smirnov test for normality, as well as Mann-Whitney U and Kruskal-Wallis tests for group comparisons, performed using SPSS version 25.

Results

The present study demonstrated a high level of nursing presence (mean ± SD: 350.8± 66.4) and a satisfactory level of nursing care quality (mean ± SD: 157.4 ± 35.9). A significant positive correlation between nursing presence and the overall quality of nursing care (r = 0.555, p < 0.001). As well as, significant positive correlations were observed between nursing presence and the psychosocial (r = 0.443, p < 0.001), communicative (r = 0.487, p < 0.001), and physical (r = 0.529, p < 0.001) dimensions of nursing care quality.

Conclusion

The findings indicate that while hospitalized patients in Iranian teaching hospitals reported a strong sense of nursing presence, their perception of the overall quality of nursing care was only moderately satisfactory. These results highlight the need to strengthen specific aspects of clinical care and technical proficiency to complement the established interpersonal strength of nursing presence.

Introduction

Quality of healthcare is an indispensable component of human well-being (Nyelisani et al., 2023). Contemporary patients consistently seek high-quality care from healthcare professionals, and the healthcare demands of diverse communities are steadily increasing. Consequently, nurses, as the largest group of healthcare providers on the frontline of delivering health services and care, are expected to meet patients’ healthcare needs through the provision of quality care (Wasik, 2020). Quality care is defined as comprehensive care that effectively addresses all patient needs with the aim of achieving optimal outcomes (Stavropoulou et al., 2022). The quality of nursing care is intrinsically linked to the nurse-patient relationship, and one of the most significant manifestations of this relationship is evident in the concept of “nursing presence,” which has garnered increasing attention in recent times.

The concept of presence has been extensively explored across various fields and disciplines throughout history; however, its introduction into the realm of nursing is relatively recent, dating back to the mid-1960s (Bozdoğan Yeşilot & Öz, 2016). Nursing presence is widely recognized as a fundamental component of effective nursing care (Fallahnezhad et al., 2021). This concept extends beyond the mere physical proximity of a nurse to a patient; it encompasses a profound connection characterized by an exchange of emotions and a shared understanding of the patient’s needs and experiences (Mahdavi et al., 2020). In essence, nursing presence signifies a constructive interaction between the nurse and patient, aimed at identifying and addressing patient concerns, clarifying their worries within a comprehensive framework, and adopting a holistic perspective that empowers the nurse to take the necessary actions to meet patient needs. Nursing presence, characterized by its focus on identifying patients’ diverse needs and ensuring nurse availability (Atashzadeh-Shoorideh et al., 2021; Mohammadipour, Atashzadeh-Shoorideh, et al., 2017a, 2017b), is centered on task-oriented/patient relationships, accountability, transparency, and comprehensive participation (Mohammadipour, Atashzadeh-Shoorideh, et al., 2017a, 2017b). Fundamentally, this concept fosters an intimate connection between the nurse and patient, enabling patients to more readily express their needs and concerns to their nurse, ultimately contributing to improved patient outcomes. The significance of nursing presence is such that it has been classified as a nursing intervention (Butcher et al., 2019; Helming et al., 2020), as its absence compromises the integrity of nursing care (Ellison & Meyer, 2020).

Review of Literature

Despite its significance, nursing presence is often hindered by organizational and cultural barriers such as understaffing, high workloads, and managerial issues, which can negatively impact care quality and satisfaction (Chegini et al., 2020; Fallahnezhad et al., 2021; Sadeghian et al., 2017). Within the specific context of Iran, qualitative studies have provided a more detailed identification of the barriers and facilitators to nursing presence. These studies have highlighted factors such as organizational culture, prevailing workplace values, and patient expectations as key determinants (Fallahnezhad et al., 2021, 2023). While these investigations offer deep insight into stakeholder experiences and perceptions, a clear research gap remains regarding the quantitative assessment of the direct relationship between patients’ perception of nursing presence and the quality of nursing care within this distinct cultural and organizational setting.

The need for this study is particularly critical within the framework of the Iranian healthcare system. This study was designed to address this gap and provide quantitative evidence to clarify this relationship. There is a critical and context-driven need for this study within Iran’s specific healthcare setting. Beyond general challenges, the Iranian system operates under a confluence of intense pressures that uniquely test the limits of nursing presence. These include severely low nurse-to-patient ratios that far exceed international benchmarks, extremely high patient turnover and overcrowding in public teaching hospitals, and chronic resource constraints exacerbated by broader economic sanctions, which directly affect staffing, equipment, and time for patient interaction. Furthermore, hierarchical structures and a task-focused culture in many Iranian hospitals may inadvertently deprioritize the psychosocial dimensions of care that are central to nursing presence. This creates a significant “practice-theory gap” where the known value of presence collides with systemic realities. Therefore, this study was designed to move beyond the identification of influencing factors and to quantitatively assess the core relationship itself. To address this gap, the present study was designed to move beyond identifying influencing factors and to provide quantitative evidence on the core relationship itself. The specific aim of this cross-sectional study was to investigate the relationship between nursing presence and quality of nursing care among hospitalized patients in teaching hospitals in Kermanshah, western Iran. The findings will provide essential data to inform strategies aimed at bridging the practice-theory gap and making nursing presence an achievable standard of care despite systemic constraints.

Methods

Study Design and Participants

This cross-sectional study employed a descriptive-analytical approach was conducted in multiple teaching hospitals in Kermanshah, Iran. While primarily describing variables at a single point in time, this design allows for the examination of associations and relationships between them. Participants were selected using a proportional quota sampling design. First, quotas were calculated for each hospital and subsequently for different inpatient wards within hospitals, based on their actual share of the patient population during the study period. Then, within each predefined quota, eligible participants who met the inclusion criteria were consecutively recruited using a convenience sampling approach until the quota for that specific ward was filled. This two-stage method ensured the final sample structurally represented the distribution of inpatients across key hospital units while remaining feasible to implement. Inclusion criteria included being at least 18 years old, having no visual, auditory, speech, or cognitive impairments, and being under nursing care for at least two days. Of the 400 questionnaires distributed, 53 were excluded from the study due to more than 10% missing data. The final sample size consisted of 347 patients, representing a response rate of 86.75%.

Sample Size

A power analysis using G*Power 3.1.9 indicated that a minimum of 302 participants were required to detect a medium effect size with 80% power at an alpha level of 0.05, based on prior literature (Mahdavi et al., 2020). To account for an anticipated non-response rate and potential incomplete data, 400 questionnaires were distributed. Ultimately, 347 completed and usable questionnaires were obtained after excluding 53 with excessive missing data (more than 10% incomplete). This final sample size exceeds the minimum number estimated by power analysis, thus maintaining adequate statistical power for the study. Questionnaires with over 10% missing data were excluded to ensure data quality and validity (Nulty, 2008)

$$\begin{array}{l}\delta =0.81\\ d=0.09\\ z_{1-\frac{\alpha }{2}}=z_{1-\frac{0.05}{2}}=z_{0.975}=1.96\\ n=\frac{{\left(z_{1-\frac{\alpha }{2}}\right)}^2\times {\left(0.81\right)}^2}{{\left(d\right)}^2}=\frac{{\left(z_{0.975}\right)}^2\times \left(0.64\right)}{{\left(0.09\right)}^2}\\ n=\frac{{\left(1.96\right)}^2\times \left(0.64\right)}{{\left(0.09\right)}^2}=\frac{\left(3.84\right)\times \left(0.64\right)}{\left(0.0081\right)}=\frac{\left(2.45\right)}{\left(0.0081\right)}=302.4\\ n\ge 302\end{array}$$

Instruments

Demographic Information Questionnaire

A researcher-developed questionnaire was used to collect demographic data from participants, including gender, marital status, age, employment status, education level, insurance status, medical history, and type of illness.

Quality Patient Care Scale (QUALPAC)

The Quality Patient Care Scale (QUALPAC) is American tool published in 1974, the result of the collaboration of two professors, Wandelt and Ager, along with faculty members at Wayne State University’s College of Nursing (Wandelt & Ager, 1974). This questionnaire has 65 questions divided into three dimensions: psychosocial (28 questions), communication (13 questions) and physical (24 questions). This tool is on the five-point Likert scale (no case: 0, rarely: 1, sometimes: 2, most of the time: 3, always: 4). The scores on this questionnaire range from 0 to 260. Scores of 0–136 are interpreted as unpleasant, scores of 137–204 are interpreted a partly satisfactory, and scores of 205–260 are interpreted as satisfactory. This questionnaire is one of the most reliable tools for measuring the quality of patient care (Redfern et al., 1993). This instrument was validated and culturally adapted in Iran by Kalvandi et al. (2022). (Kalvandi, 2022). Of the original items, 55 were retained with strong content validity (CVI = 0.968). Factor analysis with principal component analysis has extracted a factor with an explanatory rate of 75.24% of the total variance. Internal consistency was high, with Cronbach’s alpha reported as 0.81 in the original study and 0.96 in the present study.

Nursing Presence Scale (PONS)

To assess nurses’ presence from the patients’ perspective, the 36-item Nursing Presence Scale (PONS), developed and psychometrically tested in Iran by Atashzadeh-Shoorideh et al., in 2022, was used (Atashzadeh-Shoorideh et al., 2022). The Nursing Presence Scale demonstrated solid cross-cultural adaptation, robust construct validity via both EFA and CFA in a large Iranian sample (n = 774), and high reliability (α = 0.94; ICC = 0.91). The questionnaire evaluates nursing presence in four dimensions: participation and assistance, conscious focus and receptive encounter, monitoring and accountability, and coordination in care. A 5-point Likert scale (ranging from 1: very low to 5: very high) was used for responses. Higher scores indicate a stronger perception of nursing presence among patients. In the study by Atashzadeh-Shoorideh et al., the instrument demonstrated high internal consistency (Cronbach’s alpha = 0.94) (Atashzadeh-Shoorideh et al., 2022). Each item contributes to the total score based on a specific factor weight derived from the initial validation study. For the dimension of Participation and Contribution (items 1-14), each item carries a weight of 4, resulting in a weighted item score range of 4 to 20 and a total dimension range of 56 to 280. Items within Conscious Focus and Receptive Approach (15-25) have a weight of 2.5, yielding item scores from 2.5 to 12.5 and a dimension total between 27.5 and 137.5. The Monitoring and Accountability dimension (items 26-31) uses a weight of 1.5 per item (range: 1.5-7.5), leading to a dimension range of 9 to 45. Finally, for Care Coordination (items 32-36), a weight of 0.5 is applied, producing item scores from 0.5 to 2.5 and a total dimension score ranging from 2.5 to 12.5. The total score was calculated by summing weighted item responses. The item weights, as per the original scale, were rounded for practical application in determining the final score range. The total score of the instrument is in the range of 95–475, with values of 95–220 indicating the low presence, 221–349 the moderate presence and 350–475 the high presence. In this study, the instrument demonstrated high internal consistency (Cronbach’s alpha = 0.94).

Data Collection

After obtaining approval from the Kermanshah University of Medical Sciences and coordinating with hospital nursing office managers, this study was conducted in teaching hospitals in Kermanshah, Iran. After verifying the inclusion criteria, explaining the study, assuring confidentiality of the information, clarifying that names and surnames were not required, and obtaining written consent, paper-based questionnaires were distributed and completed. Completing the questionnaires typically took between 10 to 15 minutes. For participants with illiteracy, face-to-face interviews were conducted.

Data Analysis

Descriptive statistics (e.g., means, standard deviations, and frequencies) were computed to summarize the data. Pearson correlation analysis was initially used to explore the relationship between nursing presence and quality of nursing care. However, due to the non-normal distribution of some variables (as indicated by the Kolmogorov-Smirnov test), non-parametric equivalents such as Spearman correlation, Mann-Whitney U test, and Kruskal-Wallis test were employed where appropriate. All statistical analyses were conducted using SPSS version 25, with a significance level of 0.05.

Ethics Approval and Consent to Participate

This study was approved by the Ethics Committee of Kermanshah University of Medical Sciences (Ethics Code: IR.KUMS.REC.1402.444). Written informed consent was obtained from all participants before their involvement in the study. Participants were informed about the study’s purpose, procedures, and data confidentiality. They were also assured that their participation was voluntary and would not influence their treatment.

Results

Of the 347 participants in this study, 51.9% were male, and 65.1% were married. The most common age group was 31-45 years (36%). Additional demographic characteristics are presented in Table 1.

Table 1.

Demographic Characteristics of Participants

Characteristics	Category	n (%)
Age (years)	18-30	64 (18.5)
	31-45	125 (36)
	46-60	91 (26.2)
	>61	67 (19.3)
Gender	Male	180 (51.9)
	Female	167 (48.1)
Marital Status	Single	79 (22.8)
	Married	226 (65.1)
	Divorced/Widowed	42 (12.1)
Education Level	Illiterate	55 (15.9)
	Primary	68 (19.6)
	High School	107 (30.8)
	University	117 (33.7)
Employment Status	Unemployed	35 (10.1)
	Employed	50 (14.4)
	Self-employed	75 (21.6)
	Retired	35 (10.1)
	Housewife	113 (32.6)
	Worker	39 (11.2)
Insurance Status	Yes	59 (17.0%)
	No	288 (83.0%)

Normality of Nursing Presence Scale (PONS) Data

The Kolmogorov-Smirnov test indicated that the distribution of all nursing presence subscales deviated significantly from normality (Table 2; p < .05). To further examine normality, skewness and kurtosis values were inspected. Although the central limit theorem suggests that large sample sizes can mitigate the effects of non-normality, A conservative threshold of [-2, 2] was employed for these statistics. Based on this criterion, the ‘Monitoring and Accountability’ and ‘Coordination in Care’ subscales were classified as non-normal.

Table 2.

Descriptive Statistics of Nursing Presence and Quality of Nursing Care

Category	Subscale	M (SD)	Min	Max	Kolmogorov–smirnov test (p)	Skewness	Kurtosis
Nursing Presence	Total	350.8 (66.4)	95	475	0.054 (0.018)	-0.24	-1.3
​	Participation and assistance	206.4 (38.8)	56	280	0.046 (0.074)	-	-
​	Conscious focus and receptive encounter	102.7 (21.1)	27.5	137.5	0.058 (0.006)	-1.8	1.03
​	Monitoring and accountability	32.6 (7.7)	9	45	0.073 (0.001)	2.05	1.8
​	Coordination in care	8.9 (2.2)	2.5	12.5	0.082 (0.001)	15.6	2
Quality of Nursing Care	Total	157.4 (35.9)	0	241	0.035 (p = 0.035)	3.3	2.8
​	Psychosocial	59.9 (15.4)	0	115	0.049 (p = 0.047)	-1.5	4.02
​	Communicative	35.3 (8.9)	0	86	0.081 (p = 0.081)	4.5	13.4
​	Physical	62.2 (15.8)	0	93	0.047 (p = 0.047)	-2.7	0.9

The mean (standard deviation) of the total PONS score was 350.8 (66.4), indicating the high level of nursing presence. The ‘Participation and Assistance’ subscale exhibited the highest mean score (206.4), while the ‘Coordination in Care’ subscale had the lowest mean (8.9). Table 2 presents the minimum and maximum scores for each subscale.

Normality of Nursing Care Quality Scale (QUALPAC) Data

The Kolmogorov-Smirnov test indicated that the distributions of all nursing care quality subscales were significantly non-normal (Table 2; p < .05). Further analysis of skewness and kurtosis confirmed this deviation, with multiple subscales exceeding the established ±2 threshold. Despite the large sample size, these findings suggest that the assumption of normality is violated for several dimensions of nursing care quality.

The mean (standard deviation) of the total QUALPAC score was 157.4 (35.9), indicating a partly satisfactory level of overall nursing care quality (Kalvandi, 2022). Among the subscales, ‘Physical’ demonstrated the highest mean score (62.2), while ‘Communicative’ exhibited the lowest (35.3). Table 2 provides a detailed breakdown of the minimum and maximum scores for each subscale.

Spearman’s correlation analysis revealed a significant positive correlation between nursing presence and the overall quality of nursing care (r = 0.555, p < 0.001). Furthermore, significant positive correlations were observed between nursing presence and the psychosocial (r = 0.443, p < 0.001), communicative (r = 0.487, p < 0.001), and physical (r = 0.529, p < 0.001) dimensions of nursing care quality (Table 3).

Table 3.

Correlation Between Nursing Presence and Quality of Care

Dimensions of nursing presence	Psychosocial (r, p)	Communicative (r, p)	Physical (r, p)	Overall quality of care (r, p)
Participation and assistance	0.420, 0.001	0.457, 0.001	0.505, 0.001	0.524, 0.001
Conscious focus and receptive encounter	0.436, 0.001	0.486, 0,001	0.513, 0.001	0.546, 0.001
Monitoring and accountability	0.419, 0.001	0.458, 0.001	0.516, 0.001	0.538, 0.001
Coordination in care	0.416, 0,001	0.448, 0.001	0.456, 0.001	0.493, 0.001
Total (Nursing Presence)	0.443, 0.001	0.487, 0.001	0.529, 0.001	0.555, 0.001

Discussion

This study aimed to examine the correlation between nursing presence and the quality of nursing care in diverse departments of educational hospitals in Kermanshah, Iran, during 2024.

Among the 347 participants in this study, 51.9% were male, and 65.1% were married, with the majority falling within the 31–45-year age group (36%). The mean total score for nursing presence was 350.8 (SD = 66.4), indicating a high level. Among its subscales, “Participation and Assistance” demonstrated the highest mean score (M = 206.4, SD = 38.8), while “Coordination in Care” yielded the lowest (M = 8.9, SD = 2.2). The mean total score for the quality of nursing care was 157.4 (SD = 35.9), reflecting an overall satisfactory level of care, with the “Physical” dimension scoring highest (M = 62.2, SD = 15.8) and the “Communicative” dimension lowest (M = 35.3, SD = 8.9). Normality tests, including the Kolmogorov–Smirnov test and evaluation of skewness and kurtosis, indicated significant deviations from normality in several subscales. Spearman’s correlation analysis revealed a statistically significant and positive association between nursing presence and the overall quality of nursing care (r = 0.555, p < 0.001). Furthermore, significant positive correlations were observed between nursing presence and the psychosocial (r = 0.443, p < 0.001), communicative (r = 0.487, p < 0.001), and physical (r = 0.529, p < 0.001) dimensions of nursing care quality.

The findings of this study revealed a moderate level of nursing presence among participants, highlighting an essential aspect of patient care that significantly influences satisfaction and overall health outcomes (Penque & Kearney, 2015).

These findings align with recent systematic reviews and updated research showing that effective nurse-patient interaction, communication skills, empathy, and responsiveness to individual patient needs are key factors in increasing patient satisfaction and enhancing the quality of nursing care (Salifu et al., 2025; Smerat et al., 2025).However, inadequate nursing presence, often due to factors like human resource shortages (Atashzadeh-Shoorideh et al., 2022), can hinder the quality of care. A primary factor contributing to this moderate level is the pervasive shortage of human resources, a well-documented global crisis often compounded by job burnout, excessive administrative burdens, and psychological stressors within the work environment. In parallel, the overall quality of nursing care was perceived as satisfactory across physical, communicative, and psychosocial dimensions. This aligns with the definition of quality care as safe, effective, and patient-centered service delivery that holistically addresses patient needs (Karaca & Durna, 2019). Various factors contribute to nursing care quality, including nurses’ clinical skills, patient interactions, resource accessibility, and the work environment. High-quality nursing care is consistently associated with reduced adverse events, faster patient recovery, and increased satisfaction (Stavropoulou et al., 2022) outcomes heavily dependent on adequate staffing (Ball et al., 2014; Drennan et al., 2024).

Regarding specific dimensions, the satisfactory level of psychosocial care in this study resonates with the recognized importance of addressing psychological, social, and emotional needs through empathetic connections (Watson, 2013), active listening (Kwame & Petrucka, 2021), and support for social connections (Al-Nawafleh, 2023).

Similarly, the findings on communicative care align with literature identifying effective, empathetic communication and active listening as cornerstones for building patient trust and satisfaction (Fakhr-Movahedi et al., 2016; Shanahan & Cunningham, 2021). The highest score in physical care is supported by evidence linking this dimension to structured protocols, adequate training, and resource availability for tasks like pain management and hygiene (Saleh, 2023; Wu et al., 2022).

The study demonstrated a significant positive correlation between nursing presence and the quality of nursing care, including psychosocial, communicative, and physical dimensions. These findings underscore the importance of investing in nursing education and increasing the number of nurses to enhance healthcare services and patient outcomes. For example, a 2025 systematic review in intensive care units found that safe nurse staffing levels were associated with a 14% reduction in hospital mortality, shorter ICU stays, and significant improvements in infection prevention and patient satisfaction, while low staffing increases risks and nurse fatigue (Elmdni, 2025). Thus, current evidence overwhelmingly confirms that adequate nurse staffing and nursing presence remain key factors in delivering high-quality, holistic nursing care that improves patient safety, satisfaction, and overall health outcomes. Effective communication is a critical component of high-quality nursing care (Sriyanti & Musharyanti, 2022), leading to increased patient satisfaction and improved outcomes. Recent studies emphasize that effective nurse-patient communication is essential for enhancing patient satisfaction and improving health outcomes (Roja & Islam, 2024). Strategies proven effective include communication skills training, culturally sensitive communication guides, therapeutic communication programs, and short workshops to boost nurses’ confidence and competence in communicating with patients (Suraya et al., 2024). These approaches foster trust, reduce patient anxiety, and encourage active patient participation in care plans, which collectively improve treatment processes and patient experiences. Furthermore, the significant correlation with psychosocial and physical care dimensions highlights how nursing presence facilitates a holistic care approach. By being physically and emotionally present, nurses can better address psychological security, social interactions, and essential physical needs like pain management and hygiene, thereby enhancing overall patient experience and outcomes.

Strengths, Limitations and Recommendations for Future Research

One of the main strengths of this study is its focus on an underexplored yet critical aspect of nursing care—nursing presence—within the Iranian healthcare context. By examining the relationship between nursing presence and multiple dimensions of care quality, this research provides a more holistic understanding of how interpersonal nurse-patient dynamics influence patient outcomes. Furthermore, the relatively large and diverse sample of hospitalized patients across multiple departments improves the representativeness of the results and adds depth to the analysis.

The findings of this study may have limited generalizability due to its geographic scope and the potential influence of cultural differences on the concept of nursing presence. The reliance on self-reported data raises the possibility of recall bias and social desirability bias. Additionally, the cross-sectional design precludes the establishment of causal relationships between nursing presence and quality of care. Future research should incorporate longitudinal designs and more diverse populations to improve the generalizability of the findings, while also accounting for additional variables—such as individual nurse characteristics, organizational and environmental factors, patient-related elements, and system-level influences—that may affect perceptions of care quality. Finally, mixed-methods or qualitative research designs may deepen the understanding of how patients perceive and interpret nursing presence, adding depth to the quantitative findings and guiding the design of presence-enhancing interventions in care delivery.

Implications for Practice

The study findings translate into clear, actionable directives for the nursing profession. Firstly, clinical nurses should consciously cultivate and prioritize their therapeutic presence—being fully attentive and emotionally available—recognizing it as a foundational element that enhances all dimensions of care quality, from psychosocial support to physical care delivery. To enable this, nursing managers and unit leaders must proactively create supportive environments by addressing systemic barriers such as excessive workloads and administrative burdens, while also integrating training on relational skills into professional development programs. At the organizational level, hospital administrators and policymakers should consider revising quality metrics to value patient-reported relational outcomes and advocate for staffing models that protect time for meaningful nurse-patient interaction. Ultimately, a coordinated focus on strengthening nursing presence across individual, managerial, and policy levels is a vital strategy for elevating overall patient care experiences and outcomes in teaching hospitals.

Conclusion

This study results demonstrate a high level of nursing presence but a partially satisfactory quality of care from the perspective of patients in Iran’s teaching hospitals. A significant positive correlation was established between nursing presence and all dimensions of nursing care quality psychosocial, communicative, and physical. These findings emphasize that nursing presence plays a crucial role in enhancing the overall quality of patient care. To optimize care outcomes, nursing managers and policymakers should prioritize strategies that enhance nursing presence and address barriers that undermine it.

ORCID iD

khalil Moradi https://orcid.org/0009-0008-8594-1374

Ethical Considerations

This study was approved by the Ethics Committee of Kermanshah University of Medical Sciences (Ethics Code: IR.KUMS.REC.1402.444).

Consent to Participate

Written informed consent was obtained from all participants before their involvement in the study. Participants were informed about the study’s purpose, procedures, and data confidentiality. They were also assured that their participation was voluntary and would not influence their treatment.

Data Availability Statement

The data analyzed during the current study are available from the corresponding author upon reasonable request.*