Health, Spirituality and Medical Ethics

 

Introduction

N

owadays, mental health as an important factor affecting the lives of the staff has been taken into consideration by many of the specialists in this field. It has been investigated in terms of the two concepts of lack of mental disorder and the feeling of satisfaction and enjoyment in life (1). Various factors exist in the professional environments that influence the staff and their work mentally and psychologically. These factors can exert either positive impacts leading to happiness and enhanced welfare or



negative effects. High workload, improper behaviors, argues between the colleagues, and failing to follow ethical principles are among the stressful occupational factors that impose negative effects on work (2).
Morality regulates good or bad standards in organizational behavior and decision-making (3). Occupational ethics is considered as a type of morality evaluating ethical principles, occupational basics, and problems that occur in the organization environment (4). The following of ethics has numerous benefits, including customer loyalty, keeping good staff, positive working environment, and avoidance form legal issues (3).
Furthermore, emotional intelligence (EI) is another remarkable variable that raises the mental health of individuals (5-7). EI is considered as the ability to identify, apply, understand, and manage self-feelings positively in order to reduce stress, promote effective relationships, improve sympathy, overcome the problems, and diminish contrasts (8). People with higher EI are more aware of their feelings and can regulate these feelings better. These individuals have higher social ability, more objective social communications, and more effective adaption strategies (9).
On the other hand, spirituality in organizations has attracted interest in the domain of organizational sciences (10) and has emerged as a novel paradigm in the organizational subjects. Ashmos and Duchon described organizational spirituality as a remarkable evolution in organizational science (11). Spirituality in work is an inspiring and motivating force toward continuous search for aim and meaning in occupational life, as well as deep understanding of the value of work, life, universe immensity, natural environment, and personal system of believes (12).
Organizational spirituality is accompanied by various positive consequences and major complications might occur for an organization in case of the lack of spirituality. As a result, the identification of effective factors is highly important. The present study examines the impacts of EI, commitment to ethical principles, and mental health on organizational spirituality.
Numerous investigations have evaluated the variables of EI, commitment to ethical principles, mental health, and organizational spirituality in pairs. The results of some studies demonstrate that EI has a significant effect on organizational spirituality (13-16). Moreover, it has been indicated that commitment to ethical principles can affect organizational spirituality (17-21).
The findings in the literature are controversial in terms of the relationship between EI and mental health. Some studies emphasized the positive relationship between the two variables (22-27), while some other investigations revealed inverse relationships between EI and mental health (28,29).
Few studies assessed the relationships between commitment to ethical principles and mental health and observed a positive correlation (30-33). Some authors evaluated the relationships between mental health and organizational spirituality and mostly reported a positive correlation between the mentioned variables (34-36).
Organizational spirituality might result in activities for organizations, humanity, and society along with responsibility for the environment. In the provincial government of Fars, Iran human resources play a key role and this organization has continual communications with the society. Therefore, it is considerable importance to evaluate the factors that affect organizational spirituality in this setting. However, unfortunately the researchers have not considered this subject.
With this background in mind, the current study aimed to evaluate the impact of EI and commitment to ethical principles on organizational spirituality concerning mental health as a mediator variable. For this purpose, the supposed model presented in Figure 1 was considered based on the theoretical reasoning and the mentioned empirical support in the literature.

Figure 1. The conceptual model for the mediatory role of mental health between emotional intelligence, commitment to ethical principles, and organizational spirituality
Methods
This descriptive correlational study with the applied approach tested the hypotheses using the previously investigated methods. The statistical population of the present study included the staff of provincial government of Fars. A total of 316 subjects were selected through random sampling utilizing Morgan table and were surveyed. In terms of ethical considerations, the required authorizations were received from the department of human resources and only the individuals who were willing to cooperate in the study filled out the questionnaire.
The data collection instruments in this study were four questionnaires addressing four variables. The questionnaire used for the assessment of organizational spirituality variable was designed according to the questionnaire of workplace spirituality by Milliman et al. (37). This survey examines the three aspects of work meaningfulness, the sense of community, and the alignment of values with the organization.
In order to evaluate EI, the Bar-on model (38) containing the components of self-awareness, social responsibility, stress tolerance, and happiness was applied. In addition, the mental health questionnaire of Goldberg et al. with 28 questions was utilized to investigate some features, including physical health, anxiety, failure in social interaction, and depression (39). Commitment to ethical principles was assessed by the questionnaire of Miller et al. with 65 questions (40). The latter questionnaire contains the aspects of wasted time, the centrality of work, delay of gratification, leisure, self-reliance, morality, and hard work.
The current investigation used Partial Least Squares Path Modeling (PLS-PM) and SmartPLS software. The PLS-PM evaluation encompasses three stages. The first step is the evaluation of the measurement model (external) in which the validity and reliability of the constructing components are determined. The second stage is the evaluation of the structural model (internal) and the third step is the calculation of the general goodness of fit (GOF).
Result
Evaluation of the Measurement Model: The validity of the research model was assessed regarding the content validity and convergent validity. The outcomes obtained by the software indicated that all the variables had an average variance extracted (AVE) of higher than 0.4. Subsequently, it could be concluded that the components can sufficiently explain the variance of research model variables and the model has a suitable validity.
Moreover, the reliability of the model was assessed by Cronbach’s alpha coefficient and composite reliability. As summarized in Table 1, the results of these evaluations demonstrate that the model in this research has favorable reliability of > 0.7. The closer this index is to 1 the higher the reliability. Table 1 shows that all the research factors had suitable validity and reliability. Composite reliability of > 0.7 is acceptable in terms of reliability assessment and it was observed for all the main factors and features. Therefore, composite reliability of all factors and aspects was acceptable.

Table 1. Results of Cronbach’s alpha, average variance extracted (AVE), the composite reliability of emotional intelligence, commitment to ethical principles, mental health, and organizational spirituality
Variable	Number of questions	Cronbach’s alpha	AVE	Composite reliability
Emotional intelligence	15	0.889	0.483	0.906
Self-awareness	5	0.774	0.597	0.855
Social Responsibility	3	0.792	0.451	0.765
Stress tolerance	4	0.711	0.462	0.773
Happiness	3	0.772	0.594	0.853
Commitment to ethical principles	65	0.918	0.455	0.928
Wasted Time	8	0.849	0.429	0.881
Centrality of Work	10	0.882	0.488	0.868
Delay of Gratification	7	0.903	0.635	0.923
Leisure	10	0.807	0.636	0.874
Self-Reliance	10	0.842	0.641	0.905
Morality/Ethics	10	0.819	0.694	0.854
Hard Work	10	0.904	0.607	0.836
Mental health	28	0.867	0.42	0.889
Physical health	7	0.719	0.469	0.813
Anxiety	7	0.718	0.611	0.824
Social dysfunction	7	0.748	0.479	0.72
depression	7	0.755	0.677	0.86
Organizational spirituality	20	0.868	0.591	0.842
Meaningful Work	6	0.781	0.48	0.81
Sense of Community	7	0.764	0.572	0.795
Alignment With Organization Values	7	0.805	0.618	0.851

 
Evaluation of the Structural Model: In order to assess the quality of the structural model, the two indices of communality and redundancy were evaluated. Table 2 shows the results of communality in which the positive numbers are indicative of suitable model quality. According to these results, the model is of a favorable quality. In addition, the R2 coefficient was considered as a key criterion for assessing the structural model and the higher values represented higher prediction accuracy. The three values of 0.19, 0.3, and 0.67 were introduced as criteria for weak, acceptable, and strong R2 values. Table 2 summarizes the values of R2, communality index, and Q2.

Table 2. Results of redundancy, communality, and R2 for emotional intelligence, commitment to ethical principles, mental health, and organizational spirituality variables
Factor (aspect)	Redundancy	Communality	R2
Emotional Intelligence	-	0.645	-
Self-awareness	0.342	0.611	0.52
Social Responsibility	0.294	0.479	0.409
Stress tolerance	0.405	0.636	0.331
Happiness	0.41	0.672	0.369
Ethical Behaviors	-	0.594	-
Wasted Time	0.49	0.572	0.354
Centrality of Work	0.307	0.451	0.4
Delay of Gratification	0.31	0.462	0.422
Leisure	0.418	0.594	0.519
Self-Reliance	0.193	0.355	0.316
Morality/Ethics	0.273	0.429	0.386
Hard Work	0392	0.488	0.378
Mental Health	0.427	0.635	0.575
Organizational spirituality	0.116	0.32	0.853
Meaningful Work	0.294	0.342	0.392
Sense of Community	0.347	0.418	0.521
Alignment With Organization Values	0.384	0.492	0.351

 
General Fitting of the Model: Following the evaluation of the measurement and structural model fitting, the general fitting was assessed using the GOF presented by Tenenhaus et al. The mentioned criterion is measured utilizing equation (1):

 
In this formula,  refers to the mean values of communality for each factor and (R^2 ) ̅ represents the mean R2 values for the internal model factors.
Using the latter equation, the GOF value for the model was calculated as follow:
 0.475
The three cutoff points of 0.01, 0.25, and 0.36 were presented as weak, moderate, and strong for the GOF (41). As a result, the obtained value of 0.475 for the GOF indicated a strong general fitting for the research model.
Testing the Hypotheses: According to the algorithm of data analysis in the SmartPLS software, the evaluation of the measurement model, structural model, and general model can be followed by assessment and test of the research hypotheses leading to the study results. The t-values higher than ±1.96 show the significance of the factors and research hypotheses (42). As demonstrated in figures 2 and 3 and Table 3, the direct impact of EI on organizational spirituality was obtained as 0.078. Consequently, considering t=1.225, which is lower than ±1.96, the latter effect is not significant and the first hypothesis is not accepted.

Figure 2. Effect coefficients for emotional intelligence, commitment to ethical principles, mental health, and organizational spirituality variables
Based on the second hypothesis, commitment to ethical principles imposes the direct influence of 0.276, which is significant (4.38) on the organizational spirituality confirming this hypothesis. Moreover, the third and fourth hypotheses showing the direct and significant impact of EI and commitment to ethical principles on mental health were confirmed with the effects of 0.374 and 0.51, respectively. Finally, the findings revealed that the fifth hypothesis as the effect of mental health on organizational spirituality was accepted with the influence of 0.663.

Figure 3. T-values for the relationships between the variables of emotional intelligence, commitment to ethical principles, mental health, and organizational spirituality

Table 3. effect coefficient, t-value, and the results of research hypotheses testing
Relationship	Effect coefficient	t-value	Result
Emotional intelligence ® Self-awareness	0.721	20.924	Confirmed
Emotional intelligence ®Social responsibility	0.639	13.285	Confirmed
Emotional intelligence ® Stress tolerance	0.575	7.881	Confirmed
Emotional intelligence ® Happiness	0.608	10.524	Confirmed
Emotional intelligence ® Organizational spirituality (H1)	0.078	1.225	Rejected
Commitment to ethical principles ® Wasted timed	0.595	9.049	Confirmed
Commitment to ethical principles ® Centrality of work	0.632	12.465	Confirmed
Commitment to ethical principles ® Delay of gratification	0.65	12.378	Confirmed
Commitment to ethical principles ® Leisure	0.72	13.38	Confirmed
Commitment to ethical principles ® Self-reliance	0.562	9.901	Confirmed
Commitment to ethical principles ® Morality/Ethics	0.621	15.49	Confirmed
Commitment to ethical principles ® Hard work	0.615	10.541	Confirmed
Commitment to ethical principles ® Organizational spirituality (H2)	0.276	4.38	Confirmed
Emotional intelligence ® Mental health (H3)	0.374	4.362	Confirmed
Commitment to ethical principles ® Mental health (H4)	0.51	6.326	Confirmed
Mental health ® Organizational spirituality (H5)	0.663	10.381	Confirmed
Organizational spirituality ® Meaningful work	0.626	10.908	Confirmed
Organizational spirituality ® Sense of community	0.722	15.456	Confirmed
Organizational spirituality ® Alignment with organization values	0.592	9.774	Confirmed
Emotional intelligence ® Mental health ® Organizational spirituality	0.374×0.663=0.247
Commitment to ethical principles ® Mental health ® Organizational spirituality	0.51×0.663=0.338

Subsequently, the main hypothesis concerning the mediatory role of mental health on the relationship between EI, commitment to ethical principles, and organizational spirituality was confirmed. Considering the confirmation of the mediatory role for mental health, EI has an indirect significant effect of 0.247 on organizational spirituality. Furthermore, commitment to the ethical considerations exerts an indirect significant impact of 0.338 on organizational spirituality. Therefore, it could be concluded that EI solely and directly cannot elevate organizational spirituality and some other factors, such as mental health and commitment to ethical principles should be taken into consideration by the management of an organization.
Discussion
The present study aimed to evaluate the mediatory role of mental health on the relationship between EI, commitment to ethical principles, and organizational spirituality among the staff of the provincial government of Fars. According to the literature, various studies assessed the mental health, EI, commitment to ethical principles, and organizational spirituality in pairs. The results of the current investigation are in line with some studies and inconsistent with some others.
In the first hypothesis, the direct effect of EI on organizational spirituality was assessed. The results showed an effective coefficient of 0.078, which is not significant considering the t-value of 1.225 that is lower than ±1.96. In other words, EI does not have the potential to enhance organizational spirituality directly.
The EI is known as a combination of potencies, abilities, and non-cognitive skills that improves personal abilities in terms of successful confrontation with the environmental pressures resulting in adopting and humanitarian behaviors and increased spirituality in an individual (13-16). The results of testing the first hypothesis were not consistent with the previous studies and EI alone cannot predict spirituality in workplace. The second hypothesis claims that commitment to ethical principles had a direct significant impact of 0.276 on organizational spirituality, which is in line with findings of similar investigations (17-21). The authors of the latter studies believed that the staff of an organization, who are committed to correct performance and follow the ethical and professional issues simultaneously are of high spirituality (17,18). This group of people has a feeling of high energy and force along with showing flexibility and tolerance in relations with the colleagues. Furthermore, these staffs consider remarkable meaning and purpose for their work (20).
Consequently, following morality in an organization could be a predictor of spirituality presence in work and the staff feel meaningfulness in their profession when they consider the principles of professional ethics (19,21). Ethics can be achieved and promote organizational spirituality by taking into consideration the compensation of staff services with the conditions of justice and commitment to a reduction in professional injuries. Therefore, considerable attention to ethical principles of the staff is recommended to the provincial government of Fars for augmenting organizational spirituality and realization of the mentioned factors.
The third hypothesis addressed the direct influence of EI on mental health the result of which indicated the significant impact (0.374) of EI on the mental health of the staff of Fars provincial government. The latter finding is not congruence with the studies that believe people with high EI are more sensitive to the issues and have lower mental health along with more stress (28, 29).
However, some studies claim that EI components, including self-awareness, social responsibility, stress tolerance, and happiness are more observed in healthy people, compared to other individuals. In other words, the control of excitements results in mental peace of the staff in the workplace (22, 24-26). Moreover, some authors believe that EI allows people to identify the feelings of themselves and others, in addition to expressing suitable reactions in the distinct conditions of work and life. As a result, decrease in anxiety is observed and the mental health of the staff is warranted (23, 27).
The findings of the third hypothesis of this investigation were in line with the mentioned results. The staff who can consider and understand their feelings and reconstruct their temper will be able to minimize the impact of stressful events and face them more easily leading to better mental health (25). Moreover, one of the important benefits of excitement regulation is the enhancement of negative excitement accompanied by the nourishment of favorable positive excitements.
Subsequently, individuals who have the skill to regulate their excitements, have higher potential for compensating negative excitements through participating in favorite activities. These excitement abilities play a remarkable role in balancing stress and mental health (23). Some types of EI protect the person from stress and result in improved adaption. For example, the ability to control excitement has a relationship with tendency to preserving positive temper and causes prevention from depression conditions.
The fourth hypothesis of this study is about the direct impact of commitment to ethical principles on mental health and the findings demonstrated that this effect of 0.51 was significant. Therefore, it could be concluded that commitment to ethical principles promotes mental health among the staff of Fars provincial government.
The results of evaluating this hypothesis are in line with the previous studies that indicated higher levels of organizational spirituality in terms of hard work, reduced absence from work, leisure, morality, and self-reliance improved mental health (30-33). Consequently, commitment to ethical principles and the creation of an ethics-based organizational environment by the managers and authorities of an organization might assist the staff considerably toward improving mental health.
Finally, in the fifth hypothesis, the direct influence of mental health on organizational spirituality was shown to be 0.663 and significant. Some authors stated in their studies that organizations can enhance some skills, such as anger management, stress overcoming, and communications between the staff and managers through holding educational workshops and attempting to make workplace favorable.
The resultant peaceful calm workplace for the staff rises mental health in the organization and improves organizational spirituality (34-36). The results of the fifth hypothesis are consistent with the findings of the mentioned authors. In other words, elevated mental health in the staff leads to enhanced organizational spirituality.
Conclusion
The five aforementioned hypotheses were tested in the present study. According to the obtained results, the main hypothesis of this research regarding the mediatory role of mental health in the relationship between EI, commitment to ethical principles, and organizational spirituality is confirmed. Therefore, it could be stated that in case an organization seeks to improve spirituality in workplace, EI alone cannot enhance the condition and mental health along with occupational morality should be taken into consideration.
Considering the direct impact of mental health on organizational spirituality, it seems essential for the managers and policy-makers to determine the indices of mental health. This process may help to determine the priorities of mental health for the staff of Fars provincial government and execute the proposed programs favorably.
Furthermore, the higher authorities of the organization should provide the conditions for creating a healthy environment toward an optimal environment for the welfare and peace of the staff. Taking into consideration the EI and ethical principles cause mental health to enhance diverse aspects, including physical function, anxiety, social performance, and depression. As a result, suitable conditions are provided for increasing spirituality in the organization.
Moreover, the findings of this investigation were indicative of the direct and indirect influence of commitment to ethical principles on organizational spirituality. On the other hand, management plays a key role in the formation and improvement of morality in an organization. Therefore, holding educational workshops for the managers concerning the identification of the ethical subjects and behaviors is of value.
In addition, this study showed that EI affects mental health directly and organizational spirituality indirectly. Consequently, the EI of the staff is recommended to be taken into consideration for selection and recruitment and the components of EI could be trained to the staff of the organization.
Similar studies in other governmental organizations in the future and comparing the results are recommended. In addition to questionnaire, we suggest utilizing qualitative methods, such as interview for data collection. In the future studies, other variables, namely personal characteristics, organizational citizenship behavior, and occupational stress can be included in the model as independent and mediatory variables and their impact on organizational spirituality might be assessed. Moreover, the findings of this study can pave the ground for research in terms of evaluating the effect of improving interventions on organizational spirituality.
Conflict of interest
The authors of the current study declare no conflict of interest for this investigation.
Acknowledgements
We would like to extend our gratitude to the managers and staff of Fars provincial government for cooperation with the authors in performing the research and completing the questionnaires.
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