Searching for ethical leadership in nursing

Post COVID-19 workplace ostracism and counterproductive behaviors: Moral leadership

BACKGROUND

The wide proliferation of Covid-19 has impacted billions of people all over the world. This catastrophic pandemic outbreak and ostracism at work have posed challenges for all healthcare professionals, especially for nurses, and have led to a significant increase in the workload, several physical and mental problems, and a change in behavior that is more negative and counterproductive. Therefore, leadership behaviors that are moral in nature serve as a trigger and lessen the adverse workplace effects on nurses' conduct.

AIM

this research is directed to explore the impact of post-COVID-19 workplace ostracism on nurses' counterproductive behavior and examine the role of moral leadership as a mediating factor in post-COVID-19 workplace ostracism and nurses' counterproductive behavior.

ETHICAL CONSIDERATION

Ethical review and approval Was received from Ethical Committee at the Faculty of Nursing, Alexandria University, Egypt.

METHODS

A cross-sectional and correlation study was implemented in all units of medical, surgical, critical and intensive care units by using three tools; moral leadership questionnaire, Workplace Ostracism Instrument (WOS), and Counterproductive Work Behaviors Questionnaire (CWBs). A convenient sample of 340 from 699 bedside nurses was granted.

RESULTS

This study revealed that nurses' perceived moderate mean percent (55.49 ± 3.46) of overall workplace ostracism and counterproductive behavior (74.69 ± 6.15). However, they perceived a low mean percentage of moral leadership. There was a significant positive correlation between workplace ostracism and counterproductive behavior. Otherwise, a significant negative correlation was found between moral leadership, workplace ostracism and counterproductive behavior. Also, this study proved the mediating effect of moral leadership in decreasing workplace ostracism by 79.3% and counterproductive behavior by 36.7%.

CONCLUSION

Hospital administrators need to be aware of the significance of moral leadership and apply integrity in the clinical setting to reduce the drawback of isolation on nurses' conduct and increase value for the organization as a whole and nurses in particular.

The relationship between ethical leadership and nurse well-being: The mediating role of workplace mindfulness

AIM

The purpose of this study was to explore the relationship between nurses' well-being and their ethical leadership, and the mediating role of workplace mindfulness in this relationship.

DESIGN

This was a quantitative cross-sectional study.

METHODS

This cross-sectional study was conducted in three tertiary hospitals in central China from May 2022 to July 2022, and the Nurses' Workplace Mindfulness, Ethical Leadership and Well-Being Scale were distributed and collected via the Internet. A total of 1579 nurses volunteered to participate in this study. SPSS 26.0 statistical software was used to analyse the data by Z-test and Spearman's rank correlation; the internal mechanism of workplace mindfulness and ethical leadership on nurses' well-being was completed by AMOS 23.0 statistical software.

RESULTS

The scores of nurses' well-being, workplace mindfulness and ethical leadership were 93.00 (81.00, 108.00), 96.00 (80.00, 112.00) and 73.00 (67.00, 81.00) respectively. The professional title, age and department atmosphere affect their well-being. Spearman's analysis showed that nurses' well-being was positively correlated with ethical leadership (r = .507, p < .01) and workplace mindfulness (r = .600, p < .01); workplace mindfulness partially mediated the relationship between ethical leadership and nurses' well-being accounting for 38.5% of the total effect ratio [p < .001, 95% CI = (0.215, 0.316)].

CONCLUSION

Nurses' well-being was at a medium level, and had a higher score in ethical leadership and workplace mindfulness, and workplace mindfulness played a partial mediating role between ethical leadership and nurses' well-being.

IMPACT

This suggests that nursing managers need to pay attention to clinical nurses' well-being experience, actively focus on the relationship among ethical leadership, workplace mindfulness and well-being and integrate core values such as positivity and morality into nurses' daily routines, so as to improve the work enthusiasm and well-being experience of clinical nurses, enhancing the nursing quality and stabilizing the nursing team.

How does ethical leadership influence nurses' job performance? Learning goal orientation as a mediator and co-worker support as a moderator

BACKGROUND

Ethical nurse leaders play a pivotal role in helping their nurse employees deliver high-quality healthcare services. However, we still lack a comprehensive understanding of the mediating and moderating mechanisms by which ethical leadership improves job performance.

PURPOSE

This study aims to investigate: (1) whether ethical leadership would enhance nurses' job performance; (2) whether learning goal orientation acts as a mediator; and (3) whether co-worker support operates as a moderator.

PARTICIPANTS AND RESEARCH CONTEXT

We collected two-wave data from 218 nurses working in hospitals located in Jiangsu, China.

RESEARCH DESIGN

A time-lagged study based on an online survey design was utilized for data collection between September 2022 and January 2023. PROCESS Model 5 was employed to test the research hypotheses.

ETHICAL CONSIDERATIONS

We obtained ethics approval from the University Ethics Committee. The nursing participants were assured that their survey responses were completely anonymous.

RESULTS AND DISCUSSION

Ethical leadership is not significantly correlated with job performance. However, ethical leadership has an indirect impact on nurses' job performance through the mediator (learning goal orientation). Moreover, co-worker support moderates the relationship between ethical leadership and job performance.

CONCLUSION

The conceptual model provides us with a fine-grained understanding of the relationship between ethical leadership and nurses' job performance. We highlight the mediating role of learning goal orientation and the moderating role of co-worker support. We suggest that healthcare organizations should devote more efforts to promoting ethical leadership, co-worker support, and learning goal orientation.

The Ethics Resource Caregiver Program: Equipping Nurses as Ethics Champions

AbstractBackground: Nurses face ethical issues and experience moral distress in their everyday work. A nursing ethics champion program was developed at a hospital in the United States.

METHODS

As part of a quality improvement project, pre- and post-training surveys were developed to assess whether the program was feasible and sustainable, enhanced nurse confidence in recognizing and addressing ethical issues and moral distress, and increased nurse knowledge of institutional resources for addressing the same. Qualitative and quantitative analyses were performed.

RESULTS

Thirteen nurses from both the critical care and medical/surgical settings participated in the program. The program proved feasible. Attrition after the educational sessions raised concerns about sustainability. Survey results suggest an association between participating in the program's educational sessions and increased nurse confidence in recognizing and addressing ethical issues and moral distress, as well as identifying institutional resources that can assist nurses with the same.

DISCUSSION

Opportunities for future nursing ethics champion programs include increasing the interactivity and duration of educational sessions, making programs multidisciplinary, and creating materials for nurses to more easily share with colleagues. It would be valuable for future research to measure the impact of nursing ethics champion programs on nursing turnover.

IMPLICATIONS

A nursing ethics champion program has the potential to help nurses feel better equipped to navigate ethical issues and moral distress in their everyday work.

Difficult Times, Difficult Decisions: Examining the Impact of Perceived Crisis Response Strategies During COVID-19

Crises, such as the COVID-19 pandemic, require rapid action to be taken by leaders, despite minimal understanding of the impact of implemented crisis management policies and procedures in organizations. This study's purpose was to establish a greater understanding of which perceived crisis response strategies were the most beneficial or detrimental to relevant perceptions and outcomes during the recent COVID-19 crisis. Using a time-lagged study design and a sample of 454 healthcare employees, latent profile analysis was used to identify strategy profiles used by organizations based on several policy/procedure categories (i.e., human-resource supportive, human-resource disadvantaging, behavioral/interactional human safety and protection-focused, and environmental and structural safety supports-focused policies and procedures). Results indicated that four perceived crisis response strategies were employed: (1) human resource-disadvantaging, (2) maximizing, (3) safety and human resource-supportive, and (4) inactive. Perceived crisis response strategy was linked to several employee well-being (e.g., work stress) and behavioral (e.g., safety behavior) outcomes via proximal perceptions (i.e., perceived organizational support, ethical leadership, and safety climate). Proximal perceptions were the most positive for employees within organizations that enacted safety and human resource-supportive policies and procedures or that utilized a maximizing approach by implementing a wide array of crisis response policies and procedures. This paper contributes to the literature by providing crucial information needed to reduce organizational decision-making time in the event of future crises.

Ethical challenges and lack of ethical language in nurse leadership

Background:

In accordance with ethical guidelines for nurses, leaders for nurse services in general are responsible for facilitating professional development and ethical reflection and to use ethical guidelines as a management tool. Research describes a gap between employees’ and nurse leaders’ perceptions of priorities.

Objective:

The purpose of this article is to gain deeper insight into how nurses as leaders in somatic hospitals describe ethical challenges.

Design and method:

We conducted individual, quality interview with 10 nurse leaders, nine females and one male nurse aged 34–64 years. We used a hermeneutical approach to analyse the data.

Ethical considerations:

The participants received oral and written information about the study. Participation in the study was voluntary, and the participants were given the opportunity to withdraw. All of them gave written consent. The Norwegian Centre for Research Data approved the research project. In addition, the head of the hospitals gave permission to conduct our study.

Findings:

Four main areas were identified: deficient ethical language, conflicting demands on nurse leaders regarding staff management, concerns regarding young nurses’ ethical consciousness and restricting factors on the creation of a climate of ethics. The nurse leaders experienced considerable pressure. An unexpected finding was the lack of – and even disregard for – an ethical language.

Discussion and conclusion:

It is crucial to recognise ethics in all types of nursing approaches and to make it explicit. Ethical language must be implemented in nursing education. It must be recognised and used in clinical practice.

Recommendations:

We recommend further research be conducted into how nurses understand the concept of ethics and how to incorporate ethical principles into clinical nursing and nurse leadership.

The usability, feasibility and fidelity of the Ethics Quarter e-learning intervention for nurse managers

BACKGROUND

Nurse managers (NMs) expect support to carry out their ethical activities in a complex health care environment. In this study, the Ethics Quarter (EQ) is suggested as a new educational ethics e-learning intervention for nurse managers. The aim of this study was to evaluate the usability, feasibility and fidelity of the EQ. The goal was to create a new way to support NMs' ethical activity profile (developing one's own ethics knowledge, influencing ethical issues, conducting or implementing ethics research, identifying and solving ethical problems) for the use of healthcare organizations.

METHODS

The EQ was developed under guidance of the criteria for complex interventions in health care (CReDECI2) guideline. A cross-sectional survey was conducted within the intervention group after a randomized controlled trial (the main study is registered in ClinicalTrials.gov with the identifier: 04234503). The participants were NM members of the Union of Health and Social Care Professionals in Finland (n = 95).

RESULTS

A system usability scale (SUS) assessed the overall usability of EQ as good (a mean SUS score of 85.40 out of 100). Positive feedback about the EQ's feasibility was reported in structured and open questions (a good, necessary and practical research knowledge-based e-learning intervention for all nurse managers) and recommendations for further development (intervention contents could be even more challenging and interactive) were highlighted. Fidelity, measured with Google Analytics, reported shorter time used by NMs on the EQ education than estimated.

CONCLUSIONS

The findings support the high usability, feasibility and average fidelity of the EQ intervention and its potential while also providing evidence for the development of future ethics education. Health care organizations would benefit from adopting the EQ to support the ethical activities and ethical activity profile of NMs. Additionally, this study provides an example of ethics intervention development and evaluation in nursing research.

'Ethics Between the Lines' - Nurses' Experiences of Ethical Challenges in Long-Term Care

In long-term care, ethical challenges are becoming increasingly apparent as the number of older patients with complex care needs increases, in parallel with growing demands for more cost-efficient care. Scarce resources, cross-pressure and value conflicts are associated with missed care, moral stress and nurses wanting to leave the profession. Through five focus group interviews, this study aimed to explore how nurses working in nursing homes and homecare services perceive, experience and manage ethical challenges in everyday work. Content analysis revealed three main themes: striving to do good; failing and being let down and getting rid of frustrations and learning from experiences. The nurses’ morality was mainly expressed through emotions that arose in specific situations. Dedicated spaces for ethical reflection and leaders who recognize that organizational conditions affect the individual nurse-patient relationship are required. Facilitating ethical reflection is an important leadership responsibility, which may also require leaders to actually participate.

Ethnographic research as an evolving method for supporting healthcare improvement skills: a scoping review

BACKGROUND

The relationship between ethnography and healthcare improvement has been the subject of methodological concern. We conducted a scoping review of ethnographic literature on healthcare improvement topics, with two aims: (1) to describe current ethnographic methods and practices in healthcare improvement research and (2) to consider how these may affect habit and skill formation in the service of healthcare improvement.

METHODS

We used a scoping review methodology drawing on Arksey and O'Malley's methods and more recent guidance. We systematically searched electronic databases including Medline, PsychINFO, EMBASE and CINAHL for papers published between April 2013 - April 2018, with an update in September 2019. Information about study aims, methodology and recommendations for improvement were extracted. We used a theoretical framework outlining the habits and skills required for healthcare improvement to consider how ethnographic research may foster improvement skills.

RESULTS

We included 283 studies covering a wide range of healthcare topics and methods. Ethnography was commonly used for healthcare improvement research about vulnerable populations, e.g. elderly, psychiatry. Focussed ethnography was a prominent method, using a rapid feedback loop into improvement through focus and insider status. Ethnographic approaches such as the use of theory and focus on every day practices can foster improvement skills and habits such as creativity, learning and systems thinking.

CONCLUSIONS

We have identified that a variety of ethnographic approaches can be relevant to improvement. The skills and habits we identified may help ethnographers reflect on their approaches in planning healthcare improvement studies and guide peer-review in this field. An important area of future research will be to understand how ethnographic findings are received by decision-makers.

Effect of ethical nurse leaders on subordinates during pandemics

BACKGROUND

As caring in times of pandemics becomes extremely stressful, the volume and intensity of nursing work witness significant increase. Ethical practices are therefore even more important for nurses and nurse leaders during this special period.

RESEARCH AIM

The aim was to explore the relationship between ethical nurse leaders and nurses' task mastery and ostracism, and to examine the mediating role of relational identification in this relationship during pandemics.

RESEARCH DESIGN

Based on social exchange theory, this study tests a theoretical model proposing that ethical nurse leaders can increase nurses' task mastery and reduce their ostracism by improving their relational identification with leaders during pandemics.

PARTICIPANTS AND RESEARCH CONTEXT

A multilevel and multi-wave field study using data from 172 nurses from 45 departments of two comprehensive hospitals was performed from April to August 2020 to test proposed hypotheses.

ETHICAL CONSIDERATIONS

We received formal approvals from the ethical committee of the hospital where we conducted this study before the data collection.

RESULTS

Ethical nurse leaders can indeed increase nurses' task mastery and reduce their ostracism during the pandemic period; furthermore, nurses' identification with their leaders mediates these relationships. We find that ethical leadership plays an even more important role in improving nurses' task mastery and reducing their ostracism that may be facilitated by pandemics this special time. Nurses will become more identified with their leaders when they are treated by ethical ways.

DISCUSSION

The study tries to advance our understanding of the important role of ethical leadership in nurse management literature and provide useful suggestions for healthcare institutions, nurse leaders, and nurses during pandemics.

CONCLUSION

Theoretical contributions and practical implications of our findings are discussed. Specifically, we suggest that healthcare institutions cultivate ethical nurse leaders to facilitate nurses' relational identification, which in turn will positively influence work outcomes.

Missed nursing care and its relationship with perceived ethical leadership

BACKGROUND

Determination of the factors affecting missed nursing care and the impact of ethical leadership is important in improving the quality of care.

AIM

This study aims to determine the missed nursing care and its relationship with perceived ethical leadership.

RESEARCH DESIGN

A cross-sectional study.

PARTICIPANTS AND RESEARCH CONTEXT

The sample consisted of 233 nurses, of whom 92.7% were staff nurses and 7.3% were charge nurses, who work in three different hospitals in Turkey. The study data were collected using a personal and professional characteristics data form, the Missed Nursing Care Survey, and the Ethical Leadership Scale.

ETHICAL CONSIDERATIONS

The study was approved by the non-interventional ethics committee of Dokuz Eylül University Ethics Committee for Noninvasive Clinical Studies. All participants' written and verbal consents were obtained.

FINDINGS

The most missed nursing care practices were ambulation, attending interdisciplinary care conferences, and discharge planning. According to the logistic regression analysis, sex, the number of patients that the nurse is in charge of giving care, the number of patients discharged in the last shift, and satisfaction with the team were determined as factors affecting missed care. No significant relationship was found between ethical leadership and missed nursing care (p > 0.05), and a weak but significant relationship was found between the clarification of duties/roles subscale and missed nursing care (r = -0.136, p < 0.05).

DISCUSSION

Ethical leaders should collaborate with policy-makers at an institutional level to particularly achieve teamwork that is effective in the provision of care, to control missed basic nursing care, and to organize working hours and at the country level to determine roles and to increase the workforce.

CONCLUSION

The results of this study contribute to the international literature on the most common type of missed nursing care, its reasons, and the relationship between the missed care and ethical leadership in a different cultural context.

The effectiveness of the Ethics Quarter intervention on the ethical activity profile of nurse managers: A randomized controlled trial

AIM

To test the effectiveness of a new ethics educational e-learning intervention, Ethics Quarter, in supporting nurse managers' ethical activity profile.

BACKGROUND

Health care organisations need evidence-based ethics interventions to support nurse managers' ethical activity profile.

METHODS

A parallel-group, individually randomized controlled trial was conducted in 2020. Finnish nurse managers nationwide [members of the Union of Health and Social Care Professionals in Finland (Tehy) trade union] were randomly allocated to intervention (n = 169) or control group (n = 172). The intervention group participated in the Ethics Quarter comprising twelve 15-min evidence-based educational 'quarters' spread over 6 weeks. The control group had standard organisational ethics structures. The primary and secondary outcomes were ethical activity profile and ethics knowledge, respectively. The Consolidated Standards of Reporting Trials (CONSORT) statement for study design and reporting was adopted.

RESULTS

Ethical activity profile showed statistically significant differences in mean changes between the groups from baseline to 10 weeks: all five dimensions were statistically significantly higher in the intervention group compared with the control group (p = <.0001).

CONCLUSION

The Ethics Quarter was effective in increasing nurse managers' ethical activity profile.

IMPLICATIONS FOR NURSING MANAGEMENT

Applying this ethics educational e-learning intervention would benefit nursing management education and health care organisations.

TRIAL REGISTRATION

clinicaltrials.gov: NCT04234503.

Ethical Leadership and Organizational Citizenship Behavior: Mediation of Trust and Psychological Well-Being

PURPOSE

Nurses' behaviors are largely influenced by their managers' leadership style. The relationships between ethical leadership, trust, psychological well-being, and organizational citizenship behaviors have rarely been investigated in nursing studies. The current study attempted to examine the relationships between perceived ethical leadership, trust, psychological health, and nurses' organizational citizenship behaviors towards their patients in the context of Chinese hospitals.

METHODS

This research adopted a cross-sectional research design. Participants were 495 nurses solicited from six hospitals in China. Hayes's PROCESS and SPSS 22 were employed to analyze the data.

RESULTS

This study demonstrated ethical leadership perceived by nurses is positively associated with trust in management and psychological well-being. Trust in management is also positively associated with nurses' organizational citizenship behaviors. The indirect effects of perceived ethical leadership on organizational citizenship behaviors through trust in management and psychological well-being were statically significant.

CONCLUSION

This study adds value to the literature by revealing ethical leadership boosts nurses' trust in leadership and their psychological well-being, resulting in more organizational citizenship behaviors towards patients in the context of the Chinese hospitals. It is suggested that the hospital management creates an environment in which all members are treated fairly to boost nurses' psychological health and improve their service quality toward patients' satisfaction.

Ethical Leadership, Flourishing, and Extra-Role Behavior Among Nurses

Introduction

The nursing literature is silent about the relationship between ethical leadership, nurses’ flourishing, and extra-role behavior. This study was carried out to contribute to the relevant field research.

Objective

The aim of the present study was to investigate the relationship between nurses’ perceptions of their nursing managers’ ethical leadership behavior, nurses’ flourishing, and their extra-role behavior.

Methods

This was a cross-sectional study involving 302 nurses from six hospitals in Damietta City, Egypt. Data were collected using the following three self-report scales: Ethical Leadership at Work questionnaire, Flourishing Scale, and extra-role behavior scale. The data were analyzed using descriptive statistical, Pearson correlation, regression analysis and the structure equation model.

Results

There was a significant positive relationship between nursing managers’ ethical leadership, nurses’ flourishing, and extra-role behavior. The regression analysis showed that the ethical leadership of nursing managers and nurses’ flourishing predict extra-role behavior.

Conclusion

Nurses with a high level of flourishing and who work with a manager exhibiting ethical leadership behavior are more likely to activate extra-role behavior. Hence, it is recommended that nursing managers embrace an ethical approach in their leadership practices and promote flourishing among nurses to encourage them to go the extra the mile in their jobs.

Ethical leadership and decision authority effects on nurses' engagement, exhaustion, and turnover intention

AIM

The aim of the present study was to investigate emotional exhaustion, work engagement, and turnover intention in the nursing profession by exploring the antecedent effects of ethical leadership and job components such as decision authority.

BACKGROUND

Emotional exhaustion, low work engagement, and high turnover intention are prevalent issues in the nursing profession. The experience of feeling overworked has led to feelings of burnout and low morale among nurses in Ireland, which has prompted the authors to identify potential variables that reduce these outcomes-in this case, ethical leadership and decision authority.

DESIGN

A descriptive, cross-sectional survey design was used across three hospital sites.

METHODS

A cross-sectional sample of 89 nurses was recruited from three Irish hospitals to capture the experience of nurses between December 2017 - February 2018. Hypotheses were tested using path model analysis.

RESULTS

Ethical leadership positively predicted decision authority among nurses. Ethical leadership also had an indirect effect on all three outcome variables (work engagement, exhaustion, and turnover intention). Further effects were noted in relation to the mediators in relation to the three outcome variables. Decision authority had a positive effect on work engagement and related to lower turnover intention.

CONCLUSIONS

The present study demonstrated the role of ethical leadership as a mechanism to positively affect job control and work experience outcomes for nurses at work. Ethical leadership style in hospitals and providing nurses with the authority to make decisions can improve their work experience and help to engage, support, and retain nurses.

IMPACT

The study found support for the positive role of ethical leadership in relation to decision authority and as a positive predictor of work engagement, negative predictor of emotional exhaustion, and turnover intention among nurses.

Nurse managers' perspectives on working with everyday ethics in long-term care

BACKGROUND

Nurse managers are expected to continuously ensure that ethical standards are met and to support healthcare workers' ethical competence. Several studies have concluded that nurses across various healthcare settings lack the support needed to provide safe, compassionate and competent ethical care.

OBJECTIVE

The aim of this study was to explore and understand how nurse managers perceive their role in supporting their staff in conducting ethically sound care in nursing homes and home nursing care.

DESIGN AND PARTICIPANTS

Qualitative individual interviews were performed with 10 nurse managers with human resources responsibilities for healthcare workers in four nursing home wards and six home nursing care districts. Content analysis was used to analyse the data.

ETHICAL CONSIDERATIONS

The Norwegian Centre for Research Data granted permission for this study.

FINDINGS

The analysis resulted in seven subcategories that were grouped into three main categories: managers' perception of the importance of the role, managers' experiences of exercising the role and managers' opportunities to fulfil the role. Challenges with conceptualizing ethics were highlighted, as well as lack of applicable tools or time and varying motivation among employees.

DISCUSSION

The leaders tended to perceive ethics as a 'personal matter' and that the need for and benefit of ethical support (e.g., ethics reflection) depended on individuals' vulnerability, attitudes, commitment and previous experiences. The managers did not seem to distinguish between their own responsibility to support ethical competence and the responsibility of the individual employee to provide ethical care.

CONCLUSIONS

Our findings suggest that nurse managers need support themselves, both to understand and to carry out their responsibilities to foster their staffs' ethical conduct. Supporting staff in conducting ethically sound care requires more than organizing meeting places for ethical reflection; it also requires greater awareness and understanding of what ethical leadership means.

Association between ethical leadership, ethical climate and organizational citizenship behavior from nurses' perspective: a descriptive correlational study

Background

Ethical leadership plays an important role in improving the organizational climate and may be have an effect on citizenship behavior. Despite the growing emphasis on ethics in organizations, little attention to has been given this issue. The purpose of this study was to identify ethical leadership, an ethical climate, and their relationship with organizational citizenship behavior from nurses’ perspective.

Methods

In this descriptive correlational study, 250 nurses in twelve teaching hospitals in Tehran were selected by multistage sampling during 2016–2017. The data were collected using Ethical Leadership Questionnaire, Hospital Ethical Climate Survey, and Organizational Citizenship Behavior Scale.

Results

The findings showed a significant correlation between ethical leadership in managers, organizational citizenship behavior (P = 0.04, r = 0.09) and an ethical climate (P < 0.001, r = 0.65). There was a significant correlation between an ethical climate and nurses’ organizational citizenship behavior (P < 0.001, r = 0.61). The regression analysis showed that ethical leadership and an ethical climate is a predictor of organizational citizenship behavior and confirms the relationship between the variables.

Conclusion

Applying an ethical leadership style and creating the necessary conditions for a proper ethical climate in hospitals lead to increased organizational citizenship behavior by staff. To achieve organizational goals, nurse managers can use these concepts to enhance nurses’ satisfaction and improve their performance.

Psychometric properties of Authentic Leadership Self-Assessment Questionnaire in a population-based sample of Polish nurses

AIM

The purpose of the study was to adapt and evaluate the psychometric characteristics of the Polish language version of the Authentic Leadership Self-Assessment Questionnaire intended for use among Registered Nurses.

DESIGN

A cross-sectional study where the Authentic Leadership Self-Assessment Questionnaire was administered to a representative group of 3,299 Polish Registered Nurses was carried out between September and November 2017.

METHODS

Linguistic-cultural adaptation of the ALSAQ was carried out according to the WHO guidelines. The following psychometric properties of the ALSAQ were evaluated: content validity (content validity index), theoretical relevance (exploratory and confirmative factor analysis), unidimensionality of subscales (principal component analysis), internal consistency (Cronbach's alpha), test-retest reliability and criterion validity.

FINDINGS

The content validity analysis revealed a need to reduce the original ALSAQ version from 16-23 items. The factor structure of ALSAQ differed from the original version. A three-factor model was better fitted to the data than a four-factor model. The three distinguished subscales (moral processing, self-awareness, and relational transparency) were characterized by unidimensionality. ALSAQ has a good internal consistency (Cronbach's alpha 0.84) and test-retest analysis confirmed stability of the measurement for subscales and particular items. Moreover, the ALSAQ-P criterion validity with external variables, being of key importance for shaping the leadership skills (self-efficacy and universal moral foundations) was confirmed.

CONCLUSIONS

Authentic leadership skills in nursing practice are characterized by their individual specificity, which was indicated in the ALSAQ validation. The ALSAQ can be considered a reliable and valid tool for self-assessment of leadership skills in a group of nursing practitioners. The identified standards help measuring strengths and weaknesses of authentic leadership.

An ethical leadership program for nursing unit managers

PURPOSE

The aims of this study were to evaluate the effect of an ethical leadership program (ELP) on ethical leadership, organizational citizenship behavior (OCB), and job outcomes of nursing unit managers (UMs) and to examine changes in staff nurses' perception about UMs' EL, OCB, job outcomes, and ethical work environments (EWEs) post-ELP.

DESIGN

A quasi-experimental (pre- and post-test design) study conducted six-month intervention (ELP) using self-reported UM survey (n=44), and staff nurses (n=158) were randomly extracted by two steps.

METHODS

The Korean version of Ethical Leadership at Work for UMs' self-ethical leadership, the Ethical Leadership Scale for staff nurses' perceived ethical leadership, a 19-item OCB scale, and six dimensions of the medium-sized Copenhagen Psychosocial Questionnaire II for job outcomes and EWEs were administered at baseline and post-intervention.

FINDINGS

UMs' ethical leadership scores differed significantly over time in people orientation (p=0.041) and concern for ethical leadership sustainability (p=0.002) adjusting for UM experience duration and nursing unit type. Total mean and level of power-sharing of ethical leadership among UMs with <5years of UM experience improved significantly over time. Of staff nurses' perception changes about UMs' ethical leadership, OCB, job outcomes, and EWEs, significant improvement over time appeared only in EWEs' work influence level (p=0.007).

CONCLUSIONS

This study provides useful information for clinical ELP development and examining the program's effect on leadership skills and followers' outcomes. Program facilitation relies on practical training methods, participant motivation, and assessment outcome designs by controlling clinical confounding factors. Findings have implications as an attempt for intervention to promote competencies related to ethical leadership of nursing unit managers.

Effects of ethical leadership on bullying and voice behavior among nurses

PURPOSE

This study aims to investigate the effects of ethical leadership on employee's bullying and voice behavior, considering poor working conditions, organizational identification and workload as mediating variables.

DESIGN/METHODOLOGY/APPROACH

Questionnaire survey design was used to elicit responses of 564 nurses from hospitals located in various cities of Pakistan.

FINDINGS

Analysis through structural equation modeling proved that ethical leadership has a positive and significant impact on both organizational identification and voice behavior, but a negative and significant impact on workload, poor working conditions and bullying at the workplace. Furthermore, organizational identification, poor working conditions and workload proved to be partial mediators.

ORIGINALITY/VALUE

The study adds value to the limited literature on ethical leadership, bullying and voice behavior in nursing. Additionally, organizational identification, workload and poor working conditions have not previously been examined as mediators.

Impact of ethical factors on job satisfaction among Korean nurses

Background:

Although numerous studies on job satisfaction among nurses have been conducted, there is a lack of research considering the ethical perspectives of leadership and organizational climate in job satisfaction.

Objective:

The purpose of this study was to clarify the impact of the ethical climate and ethical leadership as perceived by nurses on job satisfaction in South Korea.

Research design:

A descriptive and correlational study was conducted with a convenience sample of 263 nurses from four general hospitals in South Korea.

Ethical considerations:

This study was approved by the Institute Review Board of Hallym University before data collection.

Results:

Job satisfaction was positively correlated with ethical climate and ethical leadership. The ethical climate in relationship with hospitals and people orientation leadership were influential factors in the level of job satisfaction among nurses.

Discussion:

Organizations in the nursing environment should pay attention to improving the ethical climate with acceptable ethical norms in the workplace and nurse leaders should respect, support and genuinely care about their nurses in ethical concerns.

The effect of nurses' ethical leadership and ethical climate perceptions on job satisfaction

BACKGROUND

The development of ethical leadership approaches plays an important role in achieving better patient care. Although studies that analyze the impact of ethical leadership on ethical climate and job satisfaction have gained importance in recent years, there is no study on ethical leadership and its relation to ethical climate and job satisfaction in our country.

OBJECTIVES

This descriptive and cross-sectional study aimed to determine the effect of nurses' ethical leadership and ethical climate perceptions on their job satisfaction.

METHODS

The study sample is composed of 285 nurses who agreed to participate in this research and who work at the internal, surgical, and intensive care units of a university hospital and a training and research hospital in İzmir, Turkey. Data were collected using Ethical Leadership Scale, Hospital Ethical Climate Scale, and Minnesota Satisfaction Scale. While the independent sample t-test, analysis of variance, Mann-Whitney U test, and Kruskal-Wallis test were used to analyze the data, the correlation analysis was used to determine the relationship between the scales.

ETHICAL CONSIDERATIONS

The study proposal was approved by the ethics committee of the Faculty of Medicine, Dokuz Eylül University.

FINDINGS

The nurses' mean scores were 59.05 ± 14.78 for the ethical leadership, 92.62 ± 17 for the ethical climate, and 62.15 ± 13.46 for the job satisfaction. The correlation between the nurses' ethical leadership and ethical climate mean scores was moderately positive and statistically significant (r = +0.625, p = 0.000), was weak but statistically significant between their ethical leadership and job satisfaction mean scores (r = +0.461, p = 0.000), and was moderately positive and statistically significant between their ethical climate and job satisfaction mean scores (r = +0.603, p = 0.000).

CONCLUSION

The nurses' ethical leadership, ethical climate, and job satisfaction levels are moderate, and there is a positive relationship between them. The nurses' perceptions of ethical leadership are influenced by their educational status, workplace, and length of service.

Nurse leaders' role in medical assistance in dying: A relational ethics approach

Recent changes to the Criminal Code of Canada have resulted in the right of competent adult Canadians to request medical assistance in dying (MAID). Healthcare professionals now can participate if the individual meets specific outlined criteria. There remains confusion and lack of knowledge about the specific role of nurses in MAID. MAID is a controversial topic and nurses may be faced with the challenge of balancing the duty to provide routine care, with moral reservations about MAID. The role of a nursing leader is to support nurses by ensuring they have the knowledge they require to care for patients requesting the service, whether or not the nurse is directly involved in the MAID process. The moral dilemmas raised by MAID provide an opportunity to look at a relational ethics approach to nursing leadership both for MAID and other difficult situations that arise in nursing practice. Relational ethics is a framework that proposes that the ethical moments in healthcare are based on relationships and fostering growth, healing, and health through the foundational concepts of mutual respect, engagement, embodiment, and environment. This article will use a relational ethics framework to examine how nursing leadership can support nurses who care for patients requesting MAID.

Exploration of pioneering as a major element of ethical leadership in nursing: A qualitative study

BACKGROUND

Commitment to ethical behavior is considered as an essential part of occupational responsibilities of nursing, and leaders' pioneering in ethical growth and development has led to the emergence of the concept of ethical leadership.

OBJECTIVE

The purpose of this study was to explain the nursing leaders' perception and experiences of pioneering in the field of ethical leadership.

METHODS

In this qualitative study, data were collected through semi-structured individual interviews. A total of 14 nursing leaders at different levels who were selected by purposeful sampling method participated in the study. Latent content analysis was used to analyze the data.

RESULTS

Of 14 participants of the study, 8 were male and 6 were female aged 38 to 56 years old with a mean managerial experience of 12 years. In the analysis of interviews, 4 subcategories of "Role Modeling", "Empowerment", "Knowledge and Skill", and "Recognition" were obtained which formed two main categories. These categories included "Leader as mentor" and "Professional insight".

CONCLUSION

Pioneering leaders are an important part of ethical leadership, and nursing leaders should not only be moral people, but also go a step further and actively promote moral behavior with a role as a mentor and model as well as having professional insight. Nursing leaders with a better understanding of these aspects can develop their capacity of strong ethical leadership and consider the aspects in their activities.

Ethical leadership outcomes in nursing: A qualitative study

Background:

Leadership style adopted by nursing managers is a key element in progress and development of nursing and quality of healthcare services received by the patients. In this regard, the role of ethical leadership is of utmost importance.

Objectives:

The objective of the study was to elaborate on the ethical leadership and its role in professional progress and growth of nurses in the light of work condition in health providing institutes.

Methods:

The study was carried out as a qualitative study following conventional content analysis method. In total, 14 nursing faculty members and nursing managers at different levels were selected through purposive sampling method. Semi-structured interviews were used for data gathering. The data were analyzed using latent content analysis and constant comparison analysis.

Ethical considerations:

This study was conducted in accordance with ethical issues in research with human participants and national rules and regulations related to informed consent and confidentiality. The study was approved by the Committee of Ethics in Research at the Shahid Beheshti University of Medical Sciences in Tehran, Iran, under the code: sbmu.rec.1393.695 on 15 February 2015.

Findings:

Five subcategories were obtained based on the analysis, which constituted two main categories including “all-inclusive satisfaction” and “productivity.” Nursing leaders highlighted the point that their ethical behavior creates “inner satisfaction of the leader,” “employees’ job satisfaction,” and “patients’ satisfaction.” Improvement of productivity was another outcome of ethical behavior of the leaders. This kind of behavior resulted in “providing better services” and “inspiring ethical behavior in the employees.” It has great influence on progress and growth of the nursing profession.

Conclusion:

By creating an ethical climate, ethical leadership leads to positive and effective outcomes—for the patients as well as for the nurses and the leaders—and professional progress and development of the nursing profession. Therefore, an ethical work environment that supports nurses’ progress and development can be developed by paying more attention to moralities in recruitment, teaching ethical values to the leaders, and using a systematic and objective approach to assess morality in the environment.

Educating for ethical leadership through web-based coaching

Background:

Ethical leadership is important for developing ethical healthcare practice. However, there is little research-based knowledge on how to stimulate and educate for ethical leadership.

Objectives:

The aim was to develop and investigate the feasibility of a 6-week web-based, ethical leadership educational programme and learn from participants’ experience.

Training programme and research design:

A training programme was developed consisting of (1) a practice part, where the participating middle managers developed and ran an ethics project in their own departments aiming at enhancing the ethical mindfulness of the organizational culture, and (2) a web-based reflection part, including online reflections and coaching while executing the ethics project. Focus group interviews were used to explore the participants’ experiences with and the feasibility of the training.

Participants and research context:

Nine middle managers were recruited from a part-time master’s programme in leadership in Oslo, Norway. The research context was the participating leaders’ work situation during the 6 weeks of training.

Ethical considerations:

Participation was voluntary, data anonymized and the confidentiality of the participating leaders/students and their institutions maintained. No patient or medical information was involved.

Findings:

Eight of the nine recruited leaders completed the programme. They evaluated the training programme as efficient and supportive, with the written, situational feedback/coaching as the most important element, enhancing reflection and motivation, counteracting a feeling of loneliness and promoting the execution of change.

Discussion:

The findings seem consistent with the basic assumptions behind the educational design, based partly on e-health research, feedback studies and organizational ethics methodology, partly on theories on workplace learning, reflection, recognition and motivation.

Conclusion:

The training programme seems feasible. It should be adjusted according to participants’ proposals and tested further in a large-scale study.

Solving work-related ethical problems

Background:

Nurse managers are responsible for solving work-related ethical problems to promote a positive ethical culture in healthcare organizations.

Objectives:

The aim of this study was to describe the activities that nurse managers use to solve work-related ethical problems. The ultimate aim was to enhance the ethical awareness of all nurse managers.

Research Design:

The data for this descriptive cross-sectional survey were analyzed through inductive content analysis and quantification.

Participants and research context:

The data were collected in 2011 using a questionnaire that included an open-ended question and background factors. Participants were nurse managers working in Finnish healthcare organizations (n = 122).

Ethical considerations:

Permission for the study was given by the Finnish Association of Academic Managers and Experts of Health Sciences.

Findings:

Nurse managers identified a variety of activities they use to solve work-related ethical problems: discussion (30%), cooperation (25%), work organization (17%), intervention (10%), personal values (9%), operational models (4%), statistics and feedback (4%), and personal examples (1%). However, these activities did not follow any common or systematic model.

Discussion and conclusion:

In the future, nurse managers need a more systematic approach to solve ethical problems. It is important to establish new kinds of ethics structures in organizations, such as a common, systematic ethical decision-making model and an ethics club for nurse manager problems, to support nurse managers in solving work-related ethical problems.

Ethical competency of nurse leaders: A qualitative study

Background:

Ethics play an important role in activating the manpower and achieving the organizational goals. The nurse leaders’ ethical behavior can promote the care quality by affecting the nurses’ performance and bringing up several positive consequences for the organization.

Objectives:

The aim of this study was to identify and describe the ethical competency of nurse leaders in cultural domains and the working conditions of the Iranian healthcare setting to arrive at a more comprehensive and specific perspective.

Methods:

This was a qualitative conventional content analysis study conducted with the participation of 14 nurse leaders at various levels. The participants were selected using the purposive sampling method, and the required data were collected using deep interview and also semi-structured interview. A deductive method of content analysis was applied in data analysis.

Ethical considerations:

This study was conducted in accord with the principles of research ethics and national rules and regulations relating to informed consent and confidentiality.

Findings:

Data analysis resulted in 17 subcategories that were subsequently grouped into three major categories including empathetic interactions, ethical behavior, and exalted manners.

Discussion:

Our findings are consistent with previous ones, yet presenting a more complete knowledge about aspects of ethical competency of nurse leaders. The nurse leaders can provide a proper behavioral model for the work environment through the use of new information.

Conclusion:

The nurse leaders introduced various aspects of ethical competency, so the leaders’ ethical competency could be promoted via planning and managing some ethical development programs. More future research is needed regarding the experiences of the subordinates and other related parties.

Crucial contextual attributes of nursing leadership towards a care ethics

Background:

It is of importance to understand and communicate caring ethics as a ground for qualitative caring environments. Research is needed on nursing attributes that are visible in nursing leadership since it may give bases for reflections related to the patterns of specific contexts.

Aim:

The aim of this study was to illuminate the meaning of crucial attributes in nursing leadership toward an ethical care of patients in psychiatric in-patient settings.

Research design:

The design of the study was descriptive and qualitative with a phenomenological hermeneutical approach.

Participants and research context:

The study comprised focus group interviews with nurses working in indoor psychiatric care who participated after giving informed consent.

Ethical considerations:

Since the topic and informants are not labeled as sensitive and subject to ethical approval, it is not covered by the ethics committee’s aim and purpose according to Swedish law. However, careful procedures have been followed according to ethics expressed in the Declaration of Helsinki.

Findings:

When identifying the thematic structures, analysis resulted in three major themes: To supply, including the following aspects: to supply evidence, to supply common space, and to supply good structures; To support, including the following aspects: to be a role model, to show appreciation and care, and to harbor; To shield, including the following aspects: to advocate, to emit non-tolerance of unethical behavior, and to reprove.

Discussion:

Leadership is challenging for nurses and plays an important role in ethical qualitative care. These findings should not be understood as a description about nurse manager’s role, which probably has different attributes and more focus on an organizational level.

Conclusion:

Making the understanding about crucial attributes explicit, the nurse may receive confirmation and recognition of crucial attributes for ethical care in order to move toward an ethical care.

Technologies in older people’s care

Background:

The tension between care-based and technology-based rationalities motivates studies concerning how technology can be used in the care sector to support the relational foundation of care.

Objectives:

This study interprets values related to care and technologies connected to the practice of good care.

Research design:

This research study was part of a development project aimed at developing innovative work practices through information and communication technology.

Participants and research context:

All staff (n = 18) working at two wards in a care facility for older people were asked to participate in interviews, and 12 accepted. We analysed the data using latent content analysis in combination with normative analysis.

Ethical considerations:

The caregivers were informed that participation was voluntary and that they could drop out at any time without providing any explanation.

Findings:

Four values were identified: ‘presence’, ‘appreciation’, ‘competence’ and ‘trust’. Caregivers wanted to focus on care receivers as unique persons, a view that they thought was compromised by time-consuming and beeping electronic devices. Appraising from next-of-kin and been seen as someone who can contribute together with knowledge to handle different situations were other desires. The caregivers also desired positive feedback from next-of-kin, as they wanted to be seen as professionals who have the knowledge and skills to handle difficult situations. In addition, the caregivers wanted their employer to trust them, and they wanted to work in a calm environment.

Discussion:

Caregivers’ desire for disturbance-free interactions, being valued for their skills and working in a trustful working environment were interpreted as their base for providing good care. The caregivers’ arguments are based on caring rationality, and sometimes they felt the technological rationality interfered with their main mission, providing quality care.

Conclusion:

Introducing new technology in caring should support the caring relationship. Although society’s overall technology-based approach may have gained popularity as a problem solver, technology-based rationality may compromise a care-based rationality. A shift in attitudes towards care as a concept on all societal levels is needed.

Ethical problems in nursing management: The views of nurse managers

BACKGROUND

Nurse managers have responsibilities relating to the quality of care, the welfare of the staff and running of the organization. Ethics plays significant role in these responsibilities. Ethical problems are part of daily management, but research in this area is limited.

OBJECTIVE

The aim of this study was to identify and describe ethical problems nurse managers encounter in their work to get more detailed and extensive view of these problems.

METHODS

The data consisted of nine interviews with nurse managers at different management levels in primary healthcare and specialized healthcare organizations, and it was analysed by inductive content analysis.

ETHICAL CONSIDERATIONS

Permission to conduct the interviews including ethical approval was given at all participating organizations according to national standards. The respondents were informed about the aim of the study, and voluntary participation, anonymous response and confidentiality were explained to them.

FINDINGS

Four main categories were found: conflicts in practical situations, lack of appreciation, disregard of problems and experienced inadequacy. Problems could also be divided to patient-related, staff-related, organization-related and other problems.

DISCUSSION

The findings correspond with results from earlier studies but add knowledge of the nature and details of nurse managers' ethical problems. New information is produced related to the ethical problems with nurse managers' own courage, motivation and values.

CONCLUSION

Nurse managers identified a variety of different ethical problems in their work. This information is useful in the development of ethics in nursing management. Further research about the frequency and intensity of nurse managers' ethical problems is needed as well as possible differences in different levels of management.

Nurses’ perceptions of professional dignity in hospital settings

Background:

The concept of dignity can be divided into two main attributes: absolute dignity that calls for recognition of an inner worth of persons and social dignity that can be changeable and can be lost as a result of different social factors and moral behaviours. In this light, the nursing profession has a professional dignity that is to be continually constructed and re-constructed and involves both main attributes of dignity.

Objectives:

The purpose of this study was to determine how nurses described nursing’s professional dignity in internal medicine and surgery departments in hospital settings.

Research design:

The research design was qualitative.

Ethical considerations:

This study was approved by the ethics committees of the healthcare organizations involved. All the participants were provided with information about the purpose and the nature of the study.

Participants:

A total of 124 nurses participated in this study.

Method:

The data were collected using 20 focus group sessions in different parts of Italy. The data were analysed by means of a conventional inductive content analysis starting from the information retrieved in order to extract meaning units and sorting the arising phenomena into conceptually meaningful categories and themes.

Results:

Nursing’s professional dignity was deeply embedded in the innermost part of individuals. Regarding the social part of dignity, a great importance was put on the values that compose nursing’s professional identity, the socio-historical background and the evolution of nursing in the area considered. The social part of dignity was also linked to collaboration with physicians and with healthcare assistants who were thought to have a central role in easing work strain. Equally important, though, was the relationship with peers and senior nurses.

Conclusion:

The organizational environments under scrutiny with their low staffing levels, overload of work and hierarchical interactions did not promote respect for the dignity of nurses. To understand these professional values, it is pivotal to comprehend the role of different health professions in their cultural milieu and the evolution of the nursing profession in diverse countries.