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clinical competency is a combination of morality , values , and their reflection on knowledge and skills .
honesty , care , communication skills , and adaptability are recognized as individual competency factors .
nurses constitute about 70% of health care teams which are the greatest health care providers   and play a crucial role in continuity of care and related services . in 1990 , delbueno emphasized regarding the clinical tasks of nurses that they should have technical and communicational skills and creative mind .
yekta stated that the need of the individuals seeking health according to an unwritten contract should be met by health care providers . to this
extent , clinical competency is required . with respect to the management and health care providing concerns . , the quality of care and then the nurses clinical competency would be guaranteed .
nowadays , development of quality of care and the capabilities of the nurses have a high priority in nursing management .
the most effective factors on clinical skills are experience , environment , use of opportunities , motivation , theoretical knowledge and personal characteristics .
furthermore , most studies have been performed in institutes mainly on the effect of spirituality and individual performance development , which are introduced as powerful factors for adaptation and adjustment in facing the problems .
several studies also confirmed the relationship between success and spirituality , and indicated that spiritual values would not only lead to working quality   but also develop the organization entirely .
so , introduction of spirituality into the workspace is a young phenomenon which affects positively the individual performance , the competency , and the organizational development .
spiritual intelligence is a new construction , i.e. a collection of individual capabilities in terms of spiritual resources which contain the effective kind of adaptation and problem - solving behavior .
it includes the highest developmental levels of cognitive , moral , interpersonal aspects , etc . , and assists the person to adjust with his environmental phenomena and achieve an internal and external integration .
this intelligence provides a general view of life in terms of the experiences and spiritual resources including the important decisions made and the daily solved problems . according to shabani et al . , spiritual intelligence
this indicates the better adaptability of nurses in facing daily stress with a higher spiritual intelligence . the authors could not find any particular study conducted in iran investigating the relation between nurses spiritual intelligence and clinical competency
therefore , it seemed necessary to determine the relationship between spiritual intelligence and clinical competency .
ethical considerations were confirmed by the mums ethics committee , and an introduction letter was received from mashhad school of nursing and midwifery which was presented to the hospitals before multi - stage sampling was conducted . at first ,
different wards were divided into four groups : general , special , intensive care , and emergency .
the number of nurses was based on the hospital size . to this extent , 88 nurses from imam reza hospital , 82 from quaem hospital , 23 from dr .
based on the grouping of wards , 58 nurses from general , 61 from special , 61 from intensive care , and 32 from emergency were selected . by the permission of head nurses , the nurses were selected randomly from each ward .
then , they were given research consent , necessary explanations , and a brief introduction of the research objectives .
degree of nursing with at least 6 months of nursing experience in the observed ward and working neither as a supervisor nor as a head nurse .
also , the selected nurses were assured that their responses had no effect on their organizational evaluation , so they were asked to answer all the questions honestly and precisely .
then , at the second stage of the research , the nurses and head nurses were instructed to complete the competency questionnaires .
the questionnaires were presented at the beginning of the work shift when the workload was low and the nurses were fresh .
the coded questionnaires of clinical competency were given to the head nurses to be completed under their direct supervision .
the questionnaires were collected after the end of each shift . in case of lack of time ,
demographic , clinical competency , and spiritual intelligence   questionnaires were used for data collection .
nurses clinical competency assessment tool contains 55 items and 7 domains ( caring , interpersonal communication , ethics and professional morality , professional development , education , critical thinking , and management ) scored by likert scaling as follows : 
 i am not competent 0i am less competent 1i am roughly competent 2i am sufficiently competent 3i am highly competent 4 . 
 
i am less competent 1 i am roughly competent 2 i am sufficiently competent 3 i am highly competent 4 .
spiritual intelligence questionnaire contains 97 questions which evaluated the eight aspects of patience , beliefs , spiritual religious practices , meaning and goal in life , divinity and slavery , internal peace , spiritual experience , self - cognition , and forgiveness .
the reliability of questionnaires was confirmed using cronbach 's alpha coefficient as 87% for spiritual intelligence , 96% for patience , 90% for beliefs and spiritual religious practices , 88% for meaning and goal in life , 84% for divinity and slavery , 96% for internal peace , 82% for spiritual experience , 85% for self - cognition , 93% for forgiveness , 84% for clinical competency , 87% for aspects of care , 91% for interpersonal communication , 84% for ethics and professional morality , 89% for professional development , 90% for education , 82% for critical thinking , and 94% for management .
finally , data collected from 212 nurses were analyzed by spss 11.5 using descriptive statistics ; for comparing means , analysis of variance ( anova ) , kruskal 
wallis , t - test , mann  whitney test were used for spiritual intelligence and its domains ; correlation test and simple linear regression were used for determining the relationship between spiritual intelligence with clinical competency , and covariance analysis for controlling the interfering variables .
the participants consisted of 70.3% ( 175 ) female and 29.7% ( 75 ) male nurses , aged 34.15  6.8 years , and their average nursing experience was 9 years .
spiritual intelligence score of participants was 297.20  31.93 ( min = 220 , max = 377 ) .
the mean of nurses spiritual intelligence score was 3.1  0.3 ( range between 1 and 4 ) . according to the results , 53.3% of nurses scored above the mean value [ chart 1 ] .
with respect to the spiritual intelligence domains , the maximum score was related to divinity and slavery ( 3.5  0.3 ) and the minimum was related to patience ( 205  0.5 ) .
the average of nurses clinical competency score was 167.1  25.8 based on self - evaluation , 160.3  31.3 based on head nurse evaluation , and 163.7  25.8 based on overall evaluation .
the mean of clinical competency score was 3.1  0.5 based on self - evaluation , 2.9  0.6 based on head nurse evaluation , and 0.3  0.4 based on overall evaluation .
based on the total score , the maximum clinical competency was related to ethics and professional morality ( 3.1  0.4 ) .
most nurses ( 53.8% , 114 nurses ) were having good level of clinical competency based on self - evaluation .
also , 48.2% ( 102 nurses ) showed an average level based on head nurse evaluation and 43.3% ( 113 nurses ) were at an average level based on total evaluation .
there was significant correlation between the three clinical competency scores which is shown in table 2 .
there was a significant relationship between nurses clinical competency and spiritual intelligence ( p = 0.003 , r = 0.487 ) .
no significant relationship was found between total clinical competency and personal and professional variables , except for the hospital .
however , significant relationship was found between spiritual intelligence domains such as internal peace with marriage ( p = 0.3 ) , patience with age ( p = 0.01 ) , and patience with word ( p = 0.04 ) . nurses distribution based on hospital , ward , shift , work hours , and second work spiritual intelligence mean score of nurses nurses mean score of spiritual health nurses clinical competency level based on self - evaluation , head nurse evaluation , and overall evaluation
the study results showed that most of the subjects had high spiritual intelligence score . this result could not be unlikely for our society , where there is inclination and tendency toward religious and spiritual values .
observed spirituality , job stress , organizational commitment , and job satisfaction among nurses in tehran .
they reported average to high level of spirituality , which is in agreement with the findings of the current study .
( 2009 ) , in their study on  nurses attitude toward spirituality and spiritual health in razi educational psychiatric center ,  showed high level of spirituality and spiritual health among nurses , while most of them were in third percentile . no study from iran
yang and mao   did not highlight spiritual intelligence among chinese nurses . in their study , among 117 nurses , 82.9% had low and 17.1% had average spiritual intelligence and none of the nurses had high spiritual intelligence .
surely , there is limitation about this concept in countries like china . according to iranian studies
, there is a general positive attitude toward spirituality , so the spiritual intelligence is above the average level in this country .
the results of the present study show that 45% of nurses still had below average level of spirituality .
therefore , it is necessary to promote nurses spirituality due to its importance in nursing .
it should be noted that the religious atmosphere in iran could have influenced the responses to the questions , which would result in higher evaluation of nurses about themselves , whereas yang 's study did not have this situation .
spiritual intelligence is not related to just divinity and slavery , but covers other domains such as forgiveness , patience , meaning and goal in life , spiritual experience , self - cognition , and internal peace .
although being very intelligent spiritually ( high level of spiritual intelligence ) , many people are not religious at all . in this study ,
two methods , self - evaluation and head nurse evaluation , were applied to assess the clinical competency . in studies such as bahreini et al . and liu et al . , self - evaluation was used as a valid assessment tool for nurses clinical competency and based on their recommendations , the head nurse evaluation was also used to assess the nurses clinical competency . in terms of clinical competency level , most of the nurses were at a good level based on self - evaluation .
most of the nurses were at an average level based on the head nurse evaluation , and also based on the total evaluation .
bahreini et al . , in their study entitled  clinical competency of nurses in university - affiliated hospitals in bushehr by self - evaluation ,  reported a good level of nurses clinical competency . in liu
's study , a good level of clinical competency using self - evaluation method is reported .
the results of these two studies confirmed the present findings in terms of self - evaluation .
based on self - evaluation , 53.8% of nurses had a good level of clinical competency , which indicates that most of the nurses considered their competency to be at this level , regarding the present conditions . however , because of the important role of the clinical competency in patients health and quality of care , the average clinical competency based on head nurse evaluation is noticeable ( 44.8% from nurses points of view and 48.2% from head
lack of motivation , job distress , low quality of continuing education programs , lack of job satisfaction and interest , improper nurse / patient ratio , and lack of standards for clinical competency could be considered as the reasons of low level of clinical competency . in the study of ghalje
( 2000 ) about the relationship between nurses clinical competency and patients satisfaction , it was shown that most nurses got average score of clinical competency , which is compatible with the head nurse score in the present study . from nurses points of view and based on overall evaluation , most competencies were related to ethics and professional morality and interpersonal communication ( 3.2  0.5 ) , which is in agreement with liu et al .
the maximum score in their study was related to interpersonal communication , whereas the remaining domains were at an eq ual level . however , the present study result was not compatible with that of bahreini et al .
it seems that the differences between scores are related to the different evaluation methods and various points of views and expectations of the individuals of their own roles . to conclude
, a significant correlation was found between spiritual intelligence and clinical competency ( self - evaluation / head nurse evaluation / overall evaluation ) .
therefore , it could be predicted that increasing spiritual intelligence leads to clinical competency development .
no study was found investigating the relationship between spiritual intelligence and clinical competency , but studies such as bagheri et al .
( 2010 ) on the relationship between spiritual intelligence and happiness , shabani et al .
, tabrizi ( entitled  effect of spiritual intelligence on mental health  ) , and amram ( entitled  effect of spiritual and excited intelligence on efficient management  ) have shown the effect of spiritual intelligence on the mental health in managers .
so , it could be concluded that spirituality could be effective on adaptation and , consequently , on work life and promotion of performance .
also , the results showed a significant correlation between spiritual intelligence and clinical competency domain ( self - evaluation , head nurse evaluation , overall evaluation ) in which the effect of spiritual intelligence on all aspects and a higher competency of more intelligent people in all domains were indicated .
spiritual intelligence is not merely have a good feeling toward others , but is the way of treating , making decision in stressful conditions , and reacting in difficult situations .
no significant relationship was found between personal and job variables . also , there was not any relationship between nursing background and spiritual intelligence . in the present study
, significant relationship was found between nursing background and patience , age and patience , and spiritual experi ences .
the cause of this relationship seems to be related to professional nature and to the way that the nurses face the stressful events such as death and spiritual trauma .
people with high spiritual intelligence have holistic considerations of life , solve their problems by positive moral characteristics , and adapt themselves effectively . as
nurses face numerous problems and stress daily , the spiritual intelligence could develop their clinical competency and quality of care .
it is recommended to improve the nurses spiritual intelligence during their education and by way of continuing education programs .
background : clinical competency is one of the most important requirements in nursing profession , based on which nurses are assessed . to obtain an effective and improved form of clinical competency , 
 several factors are observed and monitored by the health educational systems . among these observed factors , spiritual intelligence 
 is considered as one of the most significant factors in nurses success and efficacy . in this study , it is aimed to determine the spiritual intelligence status and its relationship with clinical competency.materials and methods : the descriptive  correlational research was carried out on 250 nurses in mashhad educational hospitals , selected by multi - stage sampling . 
 demographic , clinical competency , and spiritual intelligence questionnaires were used for data collection and 212 questionnaires were analyzed.results:about 53.3% of nurses obtained above average scores in spiritual intelligence . 
 clinical competency was evaluated by both self - evaluation and head nurse evaluation methods . 
 most nurses ( 53.8% ) were having good level of clinical competency based on self - evaluation , 48.2% were at average level based on head nurse evaluation , and 53.3% were at average level based on overall score . 
 a significant correlation was found between spiritual intelligence and clinical competency.conclusions:in this study , the positive significant correlation between nurses spiritual intelligence and their clinical competency is investigated . because of the positive effects of spiritual intelligence on nurses clinical competency and quality of care , it is recommended to develop nurses spiritual intelligence during their education and by way of continuous medical education .