An ethical framework for developing and sustaining a healthy workplace

Experiences of a PAR Intervention in Care for Older People

Participatory action research (PAR) is an approach for dealing with problematic areas in practice. Follow-up studies in which participants describe their participation in PAR in detail are rare. This follow-up study aimed to describe care providers' (CPs) experiences of having participated in a PAR intervention designed to assist them to constructively deal with troubled conscience. Twenty-nine CPs who participated in a PAR intervention were interviewed 2 to 4 months post-intervention. Content analysis was used to analyze the data. The analysis revealed three main categories: the importance of having a communal and collaborative meeting place, perceived changes in daily life, and "It has been good, but it has not solved all of our problems." Using PAR to deal with troubled conscience might be an important organizational investment for the future that can help prevent ill health among CPs and maintain or improve the quality of care.

Assessments of Stress of Conscience, Perceptions of Conscience, Burnout, and Social Support Before and After Implementation of a Participatory Action-Research-Based Intervention

Interventions aiming to constructively address stress of conscience are rare. The aim of the study was to compare assessments of stress of conscience, perceptions of conscience, burnout, and social support among health care personnel (HCP) working in municipal residential care of older adults, before and after participation in a participatory action research (PAR) intervention aiming to learn to constructively deal with troubled conscience. Questionnaire data were collected at baseline and at follow-up (1-year interval; n = 29). Descriptive statistics and nonparametric statistical tests were used to make comparisons between baseline and follow-up. HCP gave significantly higher scores to the question, “Are your work achievements appreciated by your immediate superior?” at follow-up compared with baseline. No significant differences in levels of stress of conscience and burnout at follow-up were found. The results suggested that a PAR intervention aiming to learn HCP to deal with their troubled conscience in difficult situations could be partially successful.

Validation of the Hospital Ethical Climate Survey for older people care

Background:

The exploration of the ethical climate in the care settings for older people is highlighted in the literature, and it has been associated with various aspects of clinical practice and nurses’ jobs. However, ethical climate is seldom studied in the older people care context. Valid, reliable, feasible measures are needed for the measurement of ethical climate.

Objectives:

This study aimed to test the reliability, validity, and sensitivity of the Hospital Ethical Climate Survey in healthcare settings for older people.

Design:

A non-experimental cross-sectional study design was employed, and a survey using questionnaires, including the Hospital Ethical Climate Survey was used for data collection. Data were analyzed using descriptive statistics, inferential statistics, and multivariable methods.

Participants and research context:

Survey data were collected from a sample of nurses working in the care settings for older people in Finland (N = 1513, n = 874, response rate = 58%) in 2011.

Ethical considerations:

This study was conducted according to good scientific inquiry guidelines, and ethical approval was obtained from the university ethics committee.

Results:

The mean score for the Hospital Ethical Climate Survey total was 3.85 (standard deviation = 0.56). Cronbach’s alpha was 0.92. Principal component analysis provided evidence for factorial validity. LISREL provided evidence for construct validity based on goodness-of-fit statistics. Pearson’s correlations of 0.68–0.90 were found between the sub-scales and the Hospital Ethical Climate Survey.

Discussion:

The Hospital Ethical Climate Survey was found able to reveal discrimination across care settings and proved to be a valid and reliable tool for measuring ethical climate in care settings for older people and sensitive enough to reveal variations across various clinical settings.

Conclusion:

The Finnish version of the Hospital Ethical Climate Survey, used mainly in the hospital settings previously, proved to be a valid instrument to be used in the care settings for older people. Further studies are due to analyze the factor structure and some items of the Hospital Ethical Climate Survey.

Examples of Holistic Good Practices in Promoting and Protecting Mental Health in the Workplace: Current and Future Challenges

Background

While attention has been paid to physical risks in the work environment and the promotion of individual employee health, mental health protection and promotion have received much less focus. Psychosocial risk management has not yet been fully incorporated in such efforts. This paper presents good practices in promoting mental health in the workplace in line with World Health Organization (WHO) guidance by identifying barriers, opportunities, and the way forward in this area.

Methods

Semistructured interviews were conducted with 17 experts who were selected on the basis of their knowledge and expertise in relation to good practice identified tools. Interviewees were asked to evaluate the approaches on the basis of the WHO model for healthy workplaces.

Results

The examples of good practice for Workplace Mental Health Promotion (WMHP) are in line with the principles and the five keys of the WHO model. They support the third objective of the WHO comprehensive mental health action plan 2013–2020 for multisectoral implementation of WMHP strategies. Examples of good practice include the engagement of all stakeholders and representatives, science-driven practice, dissemination of good practice, continual improvement, and evaluation. Actions to inform policies/legislation, promote education on psychosocial risks, and provide better evidence were suggested for higher WMHP success.

Conclusion

The study identified commonalities in good practice approaches in different countries and stressed the importance of a strong policy and enforcement framework as well as organizational responsibility for WMHP. For progress to be achieved in this area, a holistic and multidisciplinary approach was unanimously suggested as a way to successful implementation.

Developing ethical skills: from sensitivity to action

Acute and critical care nurses routinely encounter ethical "quandaries" such as providing perceived futile care. Other everyday ethically important occurrences may go unrecognized, however, thus diminishing their importance to moral nursing practice. This column presents a framework that may assist in developing specific skills to recognize and engage in both critical and everyday ethical situations with confidence. James Rest's Four Component Model addresses the role of the moral practitioner from initial recognition that an ethical situation exists to implementation of a justifiable action. Patient/provider scenarios are used to illustrate components of Rest's model followed by an approach to distinguish ethical from nonethical situations. Practical strategies to enhance ethical skills such as development of nursing ethics groups and providing continuing ethics education also are presented.