Person‐Centred Care Among Intensive Care Unit Nurses: The Role of Delirium Care Burden, Nursing Competency and Positive Organisational Culture

ABSTRACT

Background

Person‐centred care (PCC) recognises patients as unique individuals and provides care through person‐centred communications.

Aim

This study aimed to examine the combined associations of nursing competency (prerequisite), positive organisational culture (care environment) and delirium care burden (contextual barrier) with PCC among intensive care unit (ICU) nurses, based on McCormack and McCance's Person‐Centred Nursing Framework.

Study Design

This descriptive cross‐sectional study included nurses working in the ICUs of a university hospital in South Korea. The data were collected between 30 June and 17 July 2023. The survey assessed general characteristics, nursing competency, positive organisational culture, delirium care burden and PCC. Data were analysed using descriptive statistics, independent t‐tests, one‐way analysis of variance, Pearson's correlation coefficients and multiple regression analysis.

Results

PCC was significantly and positively correlated with nursing competency (r = 0.37, p < 0.001) and positive organisational culture (r = 0.46, p < 0.001). Multiple regression analysis revealed that positive organisational culture (β = 0.39, p < 0.001) and nursing competency (β = 0.27, p < 0.001) were significantly associated with PCC, whereas delirium care burden was not significantly associated with it.

Conclusions

To enhance PCC in ICUs, it is essential to strengthen nursing competency (prerequisite) and foster a positive organisational culture (care environment). The lack of a significant association between delirium care burden and PCC suggests that ICU nurses maintain person‐centred practices despite care strains.

Relevance to Clinical Practice

To improve nursing competency and organisational culture, competency development programmes tailored to the professional characteristics of ICU nurses are necessary, along with adequate resource allocation and human resource management. Furthermore, organisational‐level efforts such as improving policy and reward systems are required to create a supportive care environment.

Impact Statements

• What is known about this topic

  • ○
    Delirium is common in intensive care units (ICUs) and increases the complexity of nursing care.
  • ○
    Providing person‐centred care (PCC) in critical care settings can be challenging due to the demanding clinical environment.
• What this paper adds

  • ○
    This study identified that nursing competency and positive organisational culture are significantly associated with PCC among ICU nurses.
  • ○
    Although the overall delirium care burden was not a significantly associated factor, the high strain related to hyperactive delirium behaviours highlights the need for targeted organisational support and education to sustain PCC.

1. Introduction

Healthcare delivery is shifting from a disease‐centred, one‐size‐fits‐all approach to a personalised, holistic model [1, 2]. The World Health Organization has established strategies to achieve people‐centred health services, highlighting the growing importance of person‐centred care (PCC) in nursing [2, 3]. PCC is defined as care that respects patients as unique individuals, acknowledges their distinct characteristics and provides care through communication focused on their specific needs [4, 5, 6].

In intensive care units (ICUs), the complexity and urgency of technical disease management, coupled with patients' frequent inability to communicate their preferences, significantly challenge the implementation of PCC [7, 8]. Nevertheless, as accumulating evidence links PCC to improved healthcare outcomes [9, 10, 11], the necessity of implementing PCC in the ICU and understanding its barriers and facilitators is increasingly recognised [7]. Therefore, identifying the factors associated with PCC among ICU nurses is crucial for improving the quality of critical care, particularly in complex organisational and workplace contexts [12].

Nursing competency, which is defined as the integration of knowledge, skills and judgement, is a fundamental prerequisite for achieving desirable outcomes in clinical practice [13, 14]. ICU nurses require high levels of professional competency, including critical thinking and decision‐making skills, to navigate the complex ICU environment [15]. Such competencies not only facilitate therapeutic relationships but are also conceptually linked to positive person‐centred outcomes, as articulated within person‐centred nursing theory [3, 4]. Thus, nursing competency is a foundational factor for effective PCC practices.

Organisational culture, comprising shared beliefs, values and behaviours within an organisation [3, 12], forms the care environment in which nursing takes place. A positive organisational culture promotes nurses' engagement and job satisfaction, creating a supportive atmosphere that enables the provision of high‐quality care [12, 16]. Because organisational culture can function as either a facilitator or a barrier to PCC [7, 17, 18], understanding its role is essential. Recent evidence has highlighted that a supportive practice environment is a significant predictor of perceived PCC among ICU nurses [19].

Delirium, a severe complication frequently observed in ICUs, is often under‐recognised and poses a significant challenge to care processes in PCC [7, 20, 21]. Symptoms such as aggression, anxiety and passivity in patients with delirium hinder communication and the establishment of mutual therapeutic relationships, which are essential for preserving human dignity [7, 22, 23]. The inability to engage patients in their care due to delirium increases nurses' workloads and contributes to the perceived burden of delirium care [23]. Furthermore, the strain of delirium care does not merely cause psychological distress for nurses [22, 23]. We therefore propose that it may function as a contextual barrier that constrains the core care processes described in person‐centred nursing theory, such as shared decision‐making and sympathetic presence [4]. Consequently, a high delirium care burden may pose challenges for the delivery of certain person‐centred processes in the ICU.

While prior studies have examined the associations between PCC and individual nurse factors, such as competence, as well as organisational factors, such as culture and practice environment, to our knowledge, no prior study has tested these specific variables together [18, 19, 24, 25]. Evidence that simultaneously integrates individual prerequisites and organisational context with contextual barriers in the ICU remains limited [7, 17].

Therefore, this study developed a conceptual framework based on McCormack and McCance's Person‐Centred Nursing Framework to identify factors associated with PCC among ICU nurses [4]. The framework comprises four interrelated constructs: prerequisites, care environment, person‐centred processes and person‐centred outcomes [4]. Prerequisites refer to nurses' professional attributes (e.g., competence and interpersonal skills) [4]. The care environment denotes contextual features that can enable or hinder person‐centred practices, including appropriate skill mix, effective staff relationships and supportive organisational systems [4]. Person‐centred processes involve care activities that operationalise person‐centredness in practice, such as engagement, shared decision‐making, sympathetic presence and working with patients' values and beliefs [4]. Person‐centred outcomes reflect the results of effective person‐centred practice, including satisfaction with care, well‐being and the therapeutic care environment [4].

Guided by this framework, nursing competency was conceptualised as a prerequisite for nurses; and positive organisational culture as a care environment factor [3]. Delirium care burden was positioned as a contextual barrier based on the premise that the behavioural and psychological demands of delirium care can restrict key person‐centred processes (e.g., engagement and working with patients' values) by creating communication barriers and frequent care interruptions that limit relational care [4, 22, 23]. Finally, nurses' PCC was conceptualised as a person‐centred nursing process associated with these prerequisite environmental and contextual factors [4].

2. Aim

This study aimed to examine the combined associations of nursing competency (prerequisite), positive organisational culture (care environment) and delirium care burden (contextual barrier) with PCC among ICU nurses. Specifically, we examined whether nursing competency and positive organisational culture were positively associated with PCC, whereas delirium care burden was negatively associated with PCC.

3. Design and Methods

3.1. Setting and Sample

This descriptive, cross‐sectional study investigated the combined associations of nursing competency, positive organisational culture and delirium care burden with PCC among ICU nurses, guided by McCormack and McCance's Person‐Centred Nursing Framework [4].

This study was conducted in five ICUs (emergency, medical, surgical, trauma and special/negative‐pressure isolation) at a university hospital in South Korea. Based on the description of professional socialisation [26], in which the transition stage comprises the initial 3 months post‐hire and the integration stage extends from 4 months to 1 year, nurses with at least 6 months of ICU experience—that is, those who had completed the transition stage—were included. Unit managers (i.e., head nurses with formal administrative authority) were excluded to ensure objectivity because the organisational culture instrument included items evaluating leadership [16]. Conversely, charge nurses, defined in this context as shift coordinators who remained engaged in direct patient care without formal administrative authority, were included. The sample size was calculated using G*Power, version 3.1. Based on a significance level (α) of 0.05, power (1−β) of 0.80, a medium effect size (f ²) of 0.15 and a conservative estimation of 12 potential independent variables (nine general characteristics and three study variables), the minimum required sample size was 127. Considering a dropout rate of 13%, the target sample size was set at 146.

3.2. Instruments

3.2.1. General Characteristics

Nine items (sex, age, educational level, marital status, religion, clinical experience, position, work‐shift pattern and nurse‐to‐patient ratio) were used to assess general characteristics.

3.2.2. Nursing Competency

Nursing competency was assessed using a 13‐item scale developed by Kim [27]. The scale was developed with reference to the Clinical Career Development Model [28] and behavioural indicators for clinical ladders used in nursing performance appraisal [29]. The instrument consists of four subdomains: scientific (three items: professional development, resource management and unit operational ability), ethical (two items: ethical value orientation and collaboration), personal (three items: confidence, self‐regulation and flexibility) and aesthetic (five items: patient understanding, patient‐centredness, clinical judgement and coping, influence and nurturing others). Items were rated on a 4‐point Likert scale, with higher scores indicating higher perceived nursing competency. In Kim's study, content validity was evaluated by an expert panel, and the reliability was reported to be acceptable [27]. In the present study, internal consistency for the total scale was Cronbach's α = 0.89.

3.2.3. Positive Organisational Culture

Positive organisational culture was assessed using a tool developed by Kim and Kim [16], with permission. It consists of 26 items across four subdomains: pursuit of common values (seven items), formation of organisational relationships based on trust (eight items), fair management system (four items) and positive leadership of the nurse unit manager (seven items). Items were rated on a 5‐point Likert scale, with higher scores indicating a more positive perception of the organisational culture. Cronbach's alpha was 0.95 in the original study [16] and 0.95 in the current study.

3.2.4. Delirium Care Burden

The Strain of Care for Delirium Index (SCDI) developed by Milisen et al. [23] was used. The tool was translated into Korean using a forward‐backwards translation process by a nursing professor and a master's degree holder in English literature to ensure semantic equivalence. The SCDI measures the difficulties that nurses experience when caring for patients with delirium. It comprises 20 items across four factors: hypoactive behaviour, hypoalert behaviour, fluctuating course/psychoneurotic behaviour and hyperactive/hyperalert behaviour. Items were rated on a 4‐point Likert scale ranging from 1 (quite easy) to 4 (quite difficult). The total score ranged from 20 to 80, with higher scores indicating greater strain. Cronbach's alpha was 0.88 at the time of development [23] and 0.89 in this study, indicating good internal consistency.

3.2.5. Person‐Centred Care

PCC was measured using the Person‐Centered Critical Care Nursing (PCCN) scale developed by Kang et al. [30] for Korean ICU nurses. This tool reflects the specific culture and environment of the Korean ICUs. It consists of 15 items across four subdomains: compassion, individuality, respect and comfort. Items were rated on a 5‐point Likert scale, with higher scores indicating a higher level of PCC. Cronbach's alpha was 0.84 in the original study [30] and 0.85 in this study.

3.3. Data Collection

The data were collected between 30 June and 17 July 2023. Questionnaires were distributed to five ICUs with the cooperation of nursing departments. Nurses who voluntarily agreed to participate signed a consent form and completed the survey, which took approximately 20 min. To minimise potential common method bias, the participants were assured of strict anonymity and confidentiality, and the completed questionnaires were immediately sealed in individual envelopes.

3.4. Data Analysis

Data were analysed using IBM SPSS Statistics version 30.0. General characteristics were analysed using descriptive statistics (frequencies and percentages), whereas the levels of the variables were evaluated using means, standard deviations, ranges, minimum values and maximum values. Prior to conducting the parametric tests, the normality of the continuous variables was verified. The absolute values of skewness ranged from 0.11 to 0.58 (criterion < 2), and absolute values of kurtosis ranged from 0.27 to 2.15 (criterion < 7), confirming that the data satisfied the assumption of a normal distribution. Differences in PCC according to general characteristics were analysed using independent t‐tests and one‐way analysis of variance (ANOVA). Correlations among the variables were analysed using Pearson's correlation coefficients. To identify the factors associated with PCC, multiple regression analysis was performed using the Enter method. Prior to multivariate analysis, univariate analyses (t‐tests and ANOVA) were conducted to screen for general characteristics. Since no general characteristics showed a statistically significant relationship with PCC, only three primary study variables were included in the final regression model to maintain model parsimony and focus on the core research hypotheses. Furthermore, the fundamental assumptions of the linear regression model were examined. Multicollinearity was checked using tolerance and the variance inflation factor (VIF), and the independence of the residuals was verified using the Durbin–Watson statistic. The assumptions of normality, linearity and homoscedasticity were assessed by inspecting the normal P–P and scatter plots of standardised residuals.

3.5. Ethical Approvals

This study was approved by the Institutional Review Board (IRB) of the Ulsan University Hospital on 16 May 2023 (Approval No. UUH 2023‐05‐004). All data were coded to ensure anonymity. The participants were informed that their participation was voluntary, that they could withdraw at any time without penalty, and that their data would be used solely for research purposes. Data were stored in a locked cabinet accessible only to the principal investigator and were destroyed after 3 years, in accordance with the Personal Information Protection Act.

4. Results

4.1. Differences in Person‐Centred Care According to General Characteristics

Of the 146 distributed questionnaires, 10 with incomplete responses were excluded, leaving a final sample of 136 for analysis (completion rate: 93.2%). The general characteristics of the participants are presented in Table 1. Most of the participants were female (n = 112, 82.4%). The largest group was aged 26–30 years (n = 78, 57.4%), followed by 21–25 years (n = 32, 23.5%), 31–35 years (n = 16, 11.8%) and 36–40 years (n = 10, 7.3%). Most held a bachelor's degree (n = 120, 88.2%) and 105 (77.2%) were single. Regarding religion, 96 (70.6%) participants reported not following a religion. In terms of clinical experience, 95 (69.9%) participants had < 5 years of experience; most were staff nurses (n = 115, 84.6%) who worked in a three‐shift rotation (n = 129, 94.8%). The nurse‐to‐patient ratio was predominantly reported as 1:2 (n = 74, 54.4%), followed by 1:1 (n = 32, 23.5%) and 1:3 (n = 30, 22.1%). There were no significant differences in the PCC according to the participants' general characteristics.

TABLE 1.

Differences in person‐centred care according to general characteristics (N = 136).

Variables	Categories	n (%)	Person‐centred care
			Mean ± SD	t or F	p
Sex	Female	112 (82.4)	3.66 ± 0.52	0.37	0.716
	Male	24 (17.6)	3.62 ± 0.50
Age (years)	21–25	32 (23.5)	3.86 ± 0.51	2.30	0.080
	26–30	78 (57.4)	3.58 ± 0.43
	31–35	16 (11.8)	3.59 ± 0.72
	36–40	10 (7.3)	3.65 ± 0.65
Education level	Bachelor's degree	120 (88.2)	3.68 ± 0.49	1.81	0.073
	Master's degree or higher	16 (11.8)	3.44 ± 0.66
Marital status	Single	105 (77.2)	3.66 ± 0.50	0.14	0.889
	Married	31 (22.8)	3.64 ± 0.58
Religion	Yes	40 (29.4)	3.68 ± 0.49	0.42	0.674
	No	96 (70.6)	3.64 ± 0.52
Clinical experience	< 5 years	95 (69.9)	3.70 ± 0.50	1.46	0.237
	5–< 10 years	31 (22.8)	3.52 ± 0.57
	≥ 10 years	10 (7.3)	3.69 ± 0.49
Position	Staff nurse	115 (84.6)	3.67 ± 0.48	0.54	0.594
	Charge nurse	21 (15.4)	3.58 ± 0.67
Work shift pattern	Three‐shift rotation	129 (94.8)	3.64 ± 0.51	0.49	0.617
	Night shift fixed	2 (1.5)	3.90 ± 0.05
	Day shift fixed	5 (3.7)	3.81 ± 0.72
Nurse‐to‐patient ratio	1:1	32 (23.5)	3.60 ± 0.54	2.21	0.114
	1:2	74 (54.4)	3.74 ± 0.52
	1:3	30 (22.1)	3.52 ± 0.44

Abbreviation: SD, Standard deviation.

4.2. Levels of Research Variables

The levels of nursing competency, positive organisational culture, delirium care burden and PCC are presented in Table 2. The mean nursing competency score was 2.60 ± 0.42 out of 4. Among the subdomains, the highest score was observed in the ‘ethical’ domain (2.91 ± 0.52), followed by the ‘personal’ (2.77 ± 0.53), ‘aesthetic’ (2.51 ± 0.46) and ‘scientific’ (2.38 ± 0.54) domains. The mean score for positive organisational culture was 3.77 ± 0.49 out of 5. For the subdomains, ‘formation of organisational relationship based on trust’ showed the highest score (3.87 ± 0.52), followed by ‘pursuit of common values’ (3.78 ± 0.54), ‘positive leadership of nurse unit manager’ (3.75 ± 0.66) and ‘fair management system’ (3.60 ± 0.60). The mean score for the delirium care burden was 2.95 ± 0.37 out of 4. Among the subdomains, ‘hyperactive/hyperalert behaviour’ presented the highest burden (3.52 ± 0.46), followed by ‘fluctuating course and psychoneurotic behaviour’ (2.86 ± 0.54), ‘hypoalert behaviour’ (2.53 ± 0.49), and ‘hypoactive behaviour’ (2.14 ± 0.58). The mean score for PCC was 3.65 ± 0.52 out of 5. For the subdomains, ‘comfort’ received the highest score (3.87 ± 0.69), followed by ‘compassion’ (3.79 ± 0.63), ‘respect’ (3.70 ± 0.68) and ‘individuality’ (3.31 ± 0.78).

TABLE 2.

Levels of research variables (N = 136).

Variables	Categories	Scale total score	Item score	Range	Min–Max
		Mean ± SD	Mean ± SD
Nursing competency	Overall	33.83 ± 5.42	2.60 ± 0.42	13–52	19–52
	Scientific	7.13 ± 1.62	2.38 ± 0.54	3–12	3–12
	Ethical	5.82 ± 1.05	2.91 ± 0.52	2–8	3–8
	Personal	8.32 ± 1.59	2.77 ± 0.53	3–12	3–12
	Aesthetic	12.57 ± 2.31	2.51 ± 0.46	5–20	6–20
Positive organisational culture	Overall	98.06 ± 12.87	3.77 ± 0.49	26–130	44–130
	Pursuit of common values	26.47 ± 3.75	3.78 ± 0.54	7–35	14–35
	Formation of organisational relationship based on trust	30.94 ± 4.14	3.87 ± 0.52	8–40	15–40
	Fair management system	14.40 ± 2.41	3.60 ± 0.60	4–20	5–20
	Positive leadership of nurse unit manager	26.25 ± 4.59	3.75 ± 0.66	7–35	7–35
Delirium care burden	Overall	59.03 ± 7.35	2.95 ± 0.37	20–80	38–74
	Hypoactive behaviour	6.43 ± 1.74	2.14 ± 0.58	3–12	3–10
	Hypoalert behaviour	10.14 ± 1.97	2.53 ± 0.49	4–16	4–15
	Fluctuating course/psychoneurotic behaviour	14.29 ± 2.68	2.86 ± 0.54	5–20	5–20
	Hyperactive/hyperalert behaviour	28.18 ± 3.68	3.52 ± 0.46	8–32	15–32
Person‐centred care	Overall	54.82 ± 7.73	3.65 ± 0.52	15–75	34–73
	Compassion	15.17 ± 2.53	3.79 ± 0.63	4–20	9–20
	Individuality	13.25 ± 3.10	3.31 ± 0.78	4–20	4–20
	Respect	14.80 ± 2.71	3.70 ± 0.68	4–20	4–20
	Comfort	11.60 ± 2.06	3.87 ± 0.69	3–15	4–15

Abbreviation: SD, Standard deviation.

4.3. Correlations Between Research Variables

The correlations between nursing competency, positive organisational culture, delirium care burden and PCC are presented in Table 3. PCC was significantly and positively correlated with positive organisational culture (r = 0.46, 95% confidence interval [CI] [0.31, 0.58], p < 0.001) and nursing competency (r = 0.37, 95% CI [0.22, 0.51], p < 0.001). In contrast, PCC showed no significant correlation with delirium care burden (r = 0.01, 95% CI [−0.16, 0.17], p = 0.946), with the CI including zero. Nursing competency was also positively correlated with positive organisational culture (r = 0.27, 95% CI [0.10, 0.42], p = 0.002). Delirium care burden was not significantly correlated with either nursing competency (r = 0.02, 95% CI [−0.15, 0.19], p = 0.782) or positive organisational culture (r = 0.05, 95% CI [−0.12, 0.22], p = 0.562).

TABLE 3.

Correlations among research variables (N = 136).

Variables	Nursing competency	Positive organisational culture	Delirium care burden	Person‐centred care
	r [95% CI]
Nursing competency	1
Positive organisational culture	0.27 [0.10, 0.42] p = 0.002	1
Delirium care burden	0.02 [−0.15, 0.19] p = 0.782	0.05 [−0.12, 0.22] p = 0.562	1
Person‐centred care	0.37 [0.22, 0.51] p < 0.001	0.46 [0.31, 0.58] p < 0.001	0.01 [−0.16, 0.17] p = 0.946	1

Abbreviation: CI, confidence interval.

4.4. Factors Associated With Person‐Centred Care

The factors associated with PCC are listed in Table 4. Multiple regression analysis was conducted to identify variables related to PCC. As no general characteristics were significantly associated with PCC in the univariate analyses, only three primary study variables were included in the regression model. Subsequently, the fundamental assumptions of the regression models were verified. The Durbin–Watson statistic was 1.95, indicating no autocorrelation of the errors. All VIF values were at or below 1.08, with tolerance values above 0.1, confirming the absence of multicollinearity. Examination of the normal P–P plot and scatterplot of standardised residuals supported the assumptions of normality, linearity and homoscedasticity.

TABLE 4.

Factors associated with person‐centred care (N = 136).

Variables	B	SE [95% CI]	β	t	p
(Constant)	20.30	6.67 [7.10, 33.50]		3.04	0.003
Nursing competency	0.38	0.11 [0.17, 0.60]	0.27	3.51	< 0.001
Positive organisational culture	0.23	0.05 [0.14, 0.32]	0.39	5.03	< 0.001
Delirium care burden	−0.02	0.08 [−0.18, 0.13]	−0.02	−0.27	0.788
		R 2 = 0.28, adjusted R 2 = 0.26, F = 16.85, p < 0.001

Abbreviations: β, standardised coefficient; B, unstandardized coefficient; CI, confidence interval; SE, standard error; R ², coefficient of determination.

The regression model was statistically significant (F = 16.85, p < 0.001) and explained 28% of the variance in PCC (R ² = 0.28, adjusted R ² = 0.26). Positive organisational culture (B = 0.23, 95% CI [0.14, 0.32], β = 0.39, p < 0.001) and nursing competency (B = 0.38, 95% CI [0.17, 0.60], β = 0.27, p < 0.001) were significant factors associated with PCC, and their confidence intervals did not include zero. By contrast, delirium care burden was not significantly associated with PCC (B = −0.02, 95% CI [−0.18, 0.13], β = −0.02, p = 0.788), with the CI including zero.

5. Discussion

This study applied McCormack and McCance's Person‐Centred Nursing Framework [4] to identify factors associated with PCC among ICU nurses. In the regression model, nursing competency and positive organisational culture together explained 28.0% of the variance in PCC, indicating a substantive association between individual and organisational factors and person‐centred practice in critical care. However, this explanatory power suggests that other unmeasured factors, such as leadership and nursing workload, are also likely related to the delivery of PCC [7, 17, 19]. While nursing competency and positive organisational culture emerged as significant factors, the delirium care burden did not demonstrate a significant relationship with PCC.

In the present study, nursing competency was identified as a significant factor associated with PCC. This finding supports the theoretical proposition that nursing competency, as a prerequisite, is closely linked to the delivery of PCC [4], and aligns with a concept analysis highlighting a professional and competent nurse as an antecedent of person‐centred nursing in ICUs [31]. In the ICU context, nurses' professional competencies comprise clinical decision‐making and communication [32], which are key components in developing therapeutic relationships [33]. Strengthening nursing competencies may facilitate PCC in the ICU. This requires the development of specialised education programmes addressing the competencies required in the ICU setting, including person‐centred aspects of care [15, 34]. Furthermore, as individual competencies vary according to career stage [15], organisations should design tailored educational programmes and provide the necessary time and financial support to encourage active participation.

Positive organisational culture emerged as a significant factor associated with PCC, consistent with a systematic review reporting that positive organisational and workplace cultures are associated with a range of patient outcomes [12] and with a study conducted in Sweden demonstrating that organisational culture is related to the implementation and sustainability of person‐centred care in hospital settings [24]. Similarly, a study of healthcare workers in China found that hospital culture characterised by internal communication, cross‐team collaboration, innovation and charismatic leadership was associated with the provision of person‐centred care through nurses' self‐efficacy [18]. These culture characteristics are conceptually consistent with positive organisational cultures that foster collaboration and active nursing practice [16]. Consequently, organisations may need to provide sufficient resources and opportunities, as well as a supportive environment, to help nurses maximise their capabilities and engage in person‐centred practices. Competent leaders must also continuously manage and support their teams to strengthen the care environment for person‐centred nursing [3, 24]. However, compared with the extensive research focusing on the work environment [7, 19], studies that specifically examine organisational culture as a distinct construct associated with PCC in critical care contexts remain limited, warranting further replication studies.

Contrary to our hypothesis that delirium care burden is negatively associated with PCC, no significant association was observed in either direction. This null result suggests that the perceived strain related to delirium care may not be directly related to reduced person‐centred nursing behaviours. Several alternative explanations have been proposed. First, a study of trauma ICU nurses in Korea [25] found that delirium nursing performance was significantly predicted by self‐efficacy, whereas delirium‐related stress was not significantly associated with either delirium nursing performance or person‐centred care. Thus, ICU nurses may strive to maintain professional care standards and person‐centred practices despite experiencing high levels of strain. Second, there may have been a measurement mismatch or insufficient conceptual alignment between the variables. The SCDI—the delirium care burden measure—captures nurses' internal strain [23], whereas PCC reflects external, relational care processes, such as individuality and comfort [30]; consequently, internal burden might not directly hinder these outward care behaviours. Finally, the relatively high and homogeneous scores for the delirium care burden suggest restricted variability within our sample, which may have limited the statistical power to detect a significant relationship. Consequently, the non‐significant effect observed in this study may reflect complex and indirect pathways rather than a simple direct association, or it may be due to the linear analytical model's inability to capture nonlinear relationships. Furthermore, future studies should explore potential mediating mechanisms, such as emotional exhaustion or reduced empathy [22], that could bridge the gap between internal strain and external care delivery, as well as moderating variables, such as supportive leadership [19], that might buffer the negative impact of care burden on person‐centred processes.

Although the delirium care burden itself was not a significant factor in this model, our findings regarding high strain levels, particularly those related to hyperactive behaviours, highlight a critical area requiring clinical attention. To address these challenges, continuous evaluation of care burden is necessary to identify which aspects of delirium are most difficult to manage and improve delirium management [23]. Multifaceted strategies that move beyond simple task‐oriented care are required [22]. Future studies should extend this work by incorporating additional delirium‐related variables, multicentre samples and patient‐reported perspectives on PCC to provide a more holistic understanding of person‐centred practices in intensive care.

6. Limitations

This study had several limitations. First, because the study was conducted at a single university hospital, the findings may not be generalisable to other settings. Second, differences in organisational culture and patient characteristics among specific ICU types (e.g., medical, surgical and traumatic) were not analysed. Third, the specific pathways or methods of PCC education received by participants were not examined. In addition, the cross‐sectional design precludes causal inference, and the use of self‐reported measures may have introduced common methods and social desirability biases.

7. Implications for Practice/Future Research

Although the delirium care burden was not significantly associated with PCC in our findings, the high level of strain reported by nurses suggests that continuous education in delirium management is essential [23]. Strengthening nurses' clinical competency and understanding through such targeted educational activities can support ICU nurses in managing complex patient demands while maintaining person‐centred approaches [34]. Furthermore, existing literature suggests that nurses' self‐efficacy in delirium management, a variable not measured in this study, is closely related to PCC delivery [25]. Therefore, future interventions should focus on enhancing both nurses' knowledge and self‐efficacy. Future research should explore the specific pathways through which these individual and organisational factors interact to sustain PCC in critical care settings.

8. Conclusion

Based on McCormack and McCance's Person‐Centred Nursing Framework, this study found that nursing competency and positive organisational culture were significant factors associated with PCC in the ICU. Although the delirium care burden was not identified as a significant factor, the reported strain of hyperactive delirium suggests that managing these specific care demands remains a relevant challenge. By exploring these individual and organisational factors within a single framework, this study provides a foundation for integrated interventions to support person‐centred practices in ICUs.

Author Contributions

Jae Eun Jang: conceptualisation, investigation, data curation, formal analysis, writing – original draft preparation, visualisation. Sangjin Ko: conceptualisation, methodology, supervision, formal analysis, writing – original draft preparation, writing – reviewing and editing, project administration.

Funding

The authors have nothing to report.

Ethics Statement

This study was approved by the Institutional Review Board (IRB) of Ulsan University Hospital on May 16, 2023 (Approval No. UUH 2023‐05‐004).

Consent

Informed consent was obtained from all participating nurses prior to data collection.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.