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Thomas TA, Kumar S, Davis FD, Boedeker P, Thammasitboon S. Structural Equation Modeling Analysis on Associations of Moral Distress and Dimensions of Organizational Culture in Healthcare: A Cross-Sectional Study of Healthcare Professionals. AJOB Empir Bioeth 2024; 15:120-132. [PMID: 38165288 DOI: 10.1080/23294515.2023.2297922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Moral distress is a complex phenomenon experienced by healthcare professionals. This study examined the relationships between key dimensions of Organizational Culture in Healthcare (OCHC)-perceived psychological safety, ethical climate, patient safety-and healthcare professionals' perception of moral distress. DESIGN Cross-sectional survey. SETTING Pediatric and adult critical care medicine, and adult hospital medicine healthcare professionals in the United States. PARTICIPANTS Physicians (n = 260), nurses (n = 256), and advanced practice providers (n = 110) participated in the study. MAIN OUTCOME MEASURES Three dimensions of OCHC were measured using validated questionnaires: Olson's Hospital Ethical Climate Survey, Agency for Healthcare Research and Quality's Patient Safety Culture Survey, and Edmondson's Team Psychological Safety Survey. The perception of moral distress was measured using the Moral Distress Amidst a Pandemic Survey. The hypothesized relationships between various dimensions were tested with structural equation modeling (SEM). RESULTS Adequate model fit was achieved in the SEM: a root-mean-square error of approximation =0.072 (90% CI 0.069 to 0.075), standardized root mean square residual = 0.056, and comparative fit index =0.926. Perceived psychological safety (β= -0.357, p <.001) and patient safety culture (β = -0.428, p<.001) were negatively related to moral distress experience. There was no significant association between ethical climate and moral distress (β = 0.106, p = 0.319). Ethical Climate, however, was highly correlated with Patient Safety Culture (factor correlation= 0.82). CONCLUSIONS We used structural equation model to test a theoretical model of multi-dimensional organizational culture and healthcare climate (OCHC) and moral distress.Significant associations were found, supporting mitigating strategies to optimize psychological safety and patient safety culture to address moral distress among healthcare professionals. Future initiatives and studies should account for key dimensions of OCHC with multi-pronged targets to preserve the moral well-being of individuals, teams, and organizations.
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Affiliation(s)
- Tessy A Thomas
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Janet Weis Children's Hospital, Geisinger Health System, Danville, PA, USA
- Center for Bioethics & Decision Sciences, Geisinger Health System, Danville, PA, USA
| | - Shelley Kumar
- Center for Research, Innovation and Scholarship in Health Professions Education, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - F Daniel Davis
- Center for Bioethics & Decision Sciences, Geisinger Health System, Danville, PA, USA
| | - Peter Boedeker
- Department of Education, Innovation and Technology, Baylor College of Medicine, Houston, TX, USA
| | - Satid Thammasitboon
- Center for Research, Innovation and Scholarship in Health Professions Education, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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Essex R, Thompson T, Evans TR, Fortune V, Kalocsányiová E, Miller D, Markowski M, Elliott H. Ethical climate in healthcare: A systematic review and meta-analysis. Nurs Ethics 2023; 30:9697330231177419. [PMID: 37459590 PMCID: PMC10710009 DOI: 10.1177/09697330231177419] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Ethical climate refers to the shared perception of ethical norms and sets the scope for what is ethical and acceptable behaviour within teams. AIM This paper sought to explore perceptions of ethical climate amongst healthcare workers as measured by the Ethical Climate Questionnaire (ECQ), the Hospital Ethical Climate Survey (HECS) and the Ethics Environment Questionnaire (EEQ). METHODS A systematic review and meta-analysis was utilised. PSYCINFO, CINAHL, WEB OF SCIENCE, MEDLINE and EMBASE were searched, and papers were included if they sampled healthcare workers and used the ECQ, HECS or EEQ. ETHICAL CONSIDERATION Ethical approval was not required. RESULTS The search returned 1020 results. After screening, 61 papers were included (n = 43 HECS, n = 15 ECQ, n = 3 EEQ). The overall sample size was over 17,000. The pooled mean score for the HECS was 3.60. Mean scores of individual studies ranged from 2.97 to 4.5. For the HECS studies, meta-regression was carried out. No relationship was found between the country of the studies, the study setting (ICU v non-ICU settings) or the mean years of experience that the sample had. For the ECQ, sub-scales had mean scores ranging from 3.41 (instrumental) to 4.34 (law) and were all observed to have significant and substantial heterogeneity. Three studies utilised the EEQ so further analysis was not carried out. CONCLUSIONS The above results provide insight into the variability of scores as measured by the HECS, ECQ and EEQ. To some extent, this variability is not surprising with studies carried out across 21 countries and in a range of healthcare systems. Results also suggest that it may be that more local and context specific factors are more important when it comes to predicting ethical climate.
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Affiliation(s)
- Ryan Essex
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Trevor Thompson
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Thomas Rhys Evans
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Vanessa Fortune
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | | | - Denise Miller
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Marianne Markowski
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Helen Elliott
- Institute for Lifecourse Development, University of Greenwich, London, UK
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Dziurka M, Ozdoba P, Olson L, Jedynak A, Ozga D, Jurek K, Dobrowolska B. Hospital ethical climate survey - selected psychometric properties of the scale and results among polish nurses and midwives. BMC Nurs 2022; 21:295. [PMID: 36324181 PMCID: PMC9628138 DOI: 10.1186/s12912-022-01067-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/05/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The hospital ethical climate affects the quality of nursing care. A positive ethical climate is likely to reduce the proportion of those who consider leaving the profession, so it is necessary to develop tools which will enable assessment and analysis of the hospital ethical climate. The aim of this study was to examine selected psychometric properties of the Polish version of the Hospital Ethical Climate Survey, assess the hospital ethical climate perceived by nurses and midwives from Polish hospitals, and to determine its correlations with job-related variables. METHODS A cross-sectional study among 558 nurses and midwives working in hospitals in Poland. RESULTS The 21-item model showed acceptable model fitness between the hypothetical model of ethical climate and the data in the study. Five items with low factor loadings were removed from the study. The internal consistency was satisfactory (0.93). The mean score for the overall hospital ethical climate was 3.62. The highest mean score of hospital ethical climate in the present study was found in the "peers" subscale and the lowest in the "physicians" subscale. A positive correlation was found between overall hospital ethical climate and respondents' satisfaction with work, salary, and working time. The hospital ethical climate was associated with problems found in nurses and midwives' work, such as: limited time for direct face-to-face care, the lack of equipment and resources to provide high-quality health care, strained relations with hospital managers and other health care professionals, limitations to one's own competences or those of other medical professionals, moral dilemmas related to patient care, the low prestige of nurses'/midwives' work, physical and mental burden, and the risk of making a mistake. CONCLUSION The Polish 21-item version of the Hospital Ethical Climate Survey is a reliable tool. Correlations revealed that relationships with managers and physicians, and working conditions should be improved in order for the hospital ethical climate to improve.
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Affiliation(s)
- Magdalena Dziurka
- grid.411484.c0000 0001 1033 7158Department of Holistic Care and Nursing Management, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Patrycja Ozdoba
- grid.411484.c0000 0001 1033 7158Department of Holistic Care and Nursing Management, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Linda Olson
- grid.261080.d0000 0000 9225 960XConsultants and previous Professor and Dean at North Park University, Chicago, IL USA
| | - Anna Jedynak
- Provincial Polyclinical Hospital, Skierniewice, Poland
| | - Dorota Ozga
- grid.13856.390000 0001 2154 3176Department of Emergency Medicine, Faculty of Medicine, University of Rzeszów, Rzeszów, Poland
| | - Krzysztof Jurek
- grid.37179.3b0000 0001 0664 8391Institute of Sociology, Faculty of Social Sciences, John Paul II Catholic University of Lublin, Lublin, Poland
| | - Beata Dobrowolska
- grid.411484.c0000 0001 1033 7158Department of Holistic Care and Nursing Management, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
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Wang L, Li D, Wei W, Zhang T, Tang W, Lu Q. The impact of clinical nurses' perception of hospital ethical climates on their organizational citizenship behavior: A cross-sectional questionnaire survey. Medicine (Baltimore) 2022; 101:e28684. [PMID: 35089219 PMCID: PMC8797529 DOI: 10.1097/md.0000000000028684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/01/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND As the main force in the development of healthcare, nurses have the longest contact time with patients in clinical practice, their perception of the hospital ethical climates affecting nurses' attitudes and related ethical issues. hospital ethical climates have become an essential environmental factor for nurses to make and implement ethical decisions. OBJECTIVE This study aims to investigate the current status of nurses' perception of the hospital ethical climates and the nurses' organizational citizenship behavior, exploring the impact of the nurse's perception of the hospital ethical climates on the nurses' organizational citizenship behavior. METHODS A cross-sectional survey adopted, random sampling and cluster sampling were used to select 624 nurses from August 2019 to February 2020. The hospital ethical climate scale and organizational citizenship behavior scale were used as the questionnaire. The data was analyzed by SPSS 21.0 software. On-the-job clinical nurses who had been employed in the hospital for more than 1 year were eligible. Nurses who were administratively punished by the hospital or health administrative authorities were excluded. RESULTS The average scores of hospital ethical climates were 4.30 (standard deviation: 0.44), with organizational citizenship behavior 4.42 (standard deviation: 0.42). The correlation coefficient between nurses' perception of hospital ethical climates and organizational citizenship behavior was 0.359 (P < .01). Nurses' perception of the relationship between managers, patients and nurses could explain 23.1% of altruistic toward colleagues; Nurses' perception of the relationship between nurses, hospital, doctors could explain 21.2% of organizational identification. Nurses' perception of the relationship between hospital, nurses and doctors could explain 12.3% of conscientiousness; Nurses' perception of the relationship between managers, doctors could explain 7.6% of interpersonal harmony. Nurses' perception of the relationship between managers, nurses and doctors could explain 6.6% of protection company resources. CONCLUSION There is a correlation between nurses' perceptions of hospital ethical climate and organizational citizenship behavior, nurses' perceptions of hospital ethical climate influencing nurses' organizational citizenship behavior in different ways. Managers should focus on the changes of nurses' perception of hospital ethical climates, to promote the nurse to make more beneficial behavior to the organization.
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Affiliation(s)
- Lu Wang
- Shanghai Children's Hospital, Shanghai, China
| | - Dan Li
- Shanghai Children's Hospital, Shanghai, China
| | - Wanhong Wei
- Zhengzhou University, Zhengzhou, Henan, China
| | - Ting Zhang
- Shanghai Children's Hospital, Shanghai, China
| | | | - Qunfeng Lu
- Shanghai Children's Hospital, Shanghai, China
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Jiang W, Zhao X, Jiang J, Zhang H, Sun S, Li X. The association between perceived hospital ethical climate and self-evaluated care quality for COVID-19 patients: the mediating role of ethical sensitivity among Chinese anti-pandemic nurses. BMC Med Ethics 2021; 22:144. [PMID: 34706723 PMCID: PMC8549414 DOI: 10.1186/s12910-021-00713-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background The COVID-19 pandemic called for a new ethical climate in the designated hospitals and imposed challenges on care quality for anti-pandemic nurses. Less was known about whether hospital ethical climate and nurses’ ethical sensitivity were associated with care quality. This study examined the association between the perceived hospital ethical climate and self-evaluated quality of care for COVID-19 patients among anti-pandemic nurses, and explored the mediating role of ethical sensitivity in this relationship. Methods A cross-sectional study was conducted through an online survey. A total of 399 anti-pandemic nurses from ten designated hospitals in three provinces of China were recruited to fill out an online survey. Multiple linear regression analysis and a bootstrap test were used to examine the relationships between ethical climate, ethical sensitivity and care quality. Results Nurses reported mean scores of 4.43 ± 0.577 (out of 5) for hospital ethical climate, 45.00 ± 7.085 (out of 54) for ethical sensitivity, and 5.35 ± 0.661 (out of 6) for self-evaluated care quality. After controlling for covariates, perceived hospital ethical climate was positively associated with self-evaluated care quality (direct effect = 0.710, 95% confidence interval [CI] 0.628, 0.792), and was partly mediated by ethical sensitivity (indirect effect = 0.078, 95% confidence interval [CI] 0.002, 0.145). Conclusions Chinese nurses who cared for COVID-19 patients perceived high levels of hospital ethical climate, ethical sensitivity, and self-evaluated care quality. Positive perceptions of hospital ethical climate were both directly associated with a higher level of self-evaluated care quality and indirectly associated, through the mediation effect of ethical sensitivity among anti-pandemic nurses.
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Affiliation(s)
- Wenjing Jiang
- Xiangya School of Nursing, Central South University, 172 Tong Zi Po Road, Changsha, 410013, Hunan, China.,Department of Nursing, Zigong First People's Hospital, Zigong, 643000, China
| | - Xing'e Zhao
- Department of Liver Transplantation, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Jia Jiang
- West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Huilin Zhang
- Department of Nursing, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Shujuan Sun
- Department of Gynecology, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, 172 Tong Zi Po Road, Changsha, 410013, Hunan, China.
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Jiang W, Zhao X, Jiang J, Zhou Q, Yang J, Chen Y, Goldsamt L, Williams AB, Li X. Hospital ethical climate associated with the professional quality of life among nurses during the early stage of COVID-19 pandemic in Wuhan, China: A cross-sectional study. Int J Nurs Sci 2021; 8:310-317. [PMID: 34307780 PMCID: PMC8283712 DOI: 10.1016/j.ijnss.2021.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/14/2021] [Accepted: 05/07/2021] [Indexed: 01/02/2023] Open
Abstract
Objectives To describe the professional quality of life and explore its associated factors among nurses coming from other areas of China to assist with the anti-epidemic fight in Wuhan and especially examine whether the hospital ethical climate was independently associated with nurses’ professional quality of life. Methods A cross-sectional online survey was conducted from March 2020 to April 2020. The nurses working in Wuhan from the other parts of China were the target population. The Professional Quality of Life Scale version 5, the Hospital Ethical Climate Survey, and a basic information sheet were used to collect data. Descriptive statistics, t-test, ANOVA, Pearson correlation, and multiple linear regression analysis were used to analyze the data. Results In total, 236 nurses participated in this study, and 219 valid questionnaires were analyzed. The average age of the participants was 31.2 ± 5.0 years. Most nurses were female (176/219; 80.4%) and married (145/219; 66.2%). In term of professional quality of life, nurses reported moderate (129/219; 58.9%) to high (90/219; 41.1%) levels of compassion satisfaction, low (119/219; 54.3%) to moderate (100/219; 45.7%) levels of burnout, and low (67/219; 36.0%) to high (10/219; 4.6%) levels of secondary traumatic stress. Regarding hospital ethical climate, nurses reported moderately high hospital ethical climates with an average score of 4.46. After controlling for socio-demographic characteristics, the multiple linear regression models showed that the hospital ethical climate subscale of “relationship with physicians” was independently associated with the compassion satisfaction (β = 0.533, P < 0.01) and burnout (β = −0.237, P < 0.05); the hospital ethical climate subscale of “relationship with peers” (β = −0.191, P < 0.01) was independently associated with the secondary traumatic stress. Conclusions During the early stage of the pandemic, nurses demonstrated moderate to high level of compassion satisfaction, low to moderate level of burnout, and all nurses experienced secondary traumatic stress. Nurses perceived a high level of hospital ethical climate, and the perceived hospital ethical climate played an important role in promoting nurses’ professional quality of life during a life-threatening infectious disease pandemic.
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Affiliation(s)
- Wenjing Jiang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.,Department of Nursing, Zigong First People's Hospital, Zigong, Sichuan, China
| | - Xing'e Zhao
- Department of Liver Transplantation, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jia Jiang
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, China
| | - Qidi Zhou
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jiahui Yang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yuqing Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Lloyd Goldsamt
- Rory Meyers College of Nursing, New York University, New York, USA
| | | | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Ventovaara P, Sandeberg MA, Räsänen J, Pergert P. Ethical climate and moral distress in paediatric oncology nursing. Nurs Ethics 2021; 28:1061-1072. [PMID: 33706607 PMCID: PMC8408826 DOI: 10.1177/0969733021994169] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Ethical climate and moral distress have been shown to affect nurses' ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field. RESEARCH AIM To investigate paediatric oncology nurses' perceptions of ethical climate and moral distress. RESEARCH DESIGN In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey-Shortened and the Swedish Moral Distress Scale-Revised. Data analysis includes descriptive statistics and non-parametric analyses. RESPONDENTS AND RESEARCH CONTEXT Ninety-three nurses, working at paediatric oncology centres in Finland, completed the survey. ETHICAL CONSIDERATIONS According to Finnish legislation, no ethical review was needed for this type of questionnaire study. Formal research approvals were obtained from all five hospitals. Return of the questionnaire was interpreted as consent to participate. RESULTS Ethical climate was perceived as positive. Although morally distressing situations were assessed as highly disturbing, in general they occurred quite rarely. The situations that did appear often reflected performing procedures on school-aged children who resist such treatment, inadequate staffing and lack of time. Perceptions of ethical climate and frequencies of morally distressing situations were inversely correlated. DISCUSSION Although the results echo the recurrent testimonies of busy work shifts, nurses could most often practise nursing the way they perceived as right. One possible explanation could be the competent and supportive co-workers, as peer support has been described as helpful in mitigating moral distress. CONCLUSION Nurturing good collegial relationships and developing manageable workloads could reduce moral distress among nurses.
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Affiliation(s)
| | | | | | - Pernilla Pergert
- 27106Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden
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Fradelos EC, Latsou D, Alikari V, Papathanasiou IV, Roupa A, Balang V, Tsaras K, Papagiannis D, Tzavella F. Greek Nurses’ Perception of Hospital Ethical Climate: A Cross-Sectional Study. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1337:17-25. [DOI: 10.1007/978-3-030-78771-4_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
AbstractWith the many changes occurring within the health system and nursing education, ongoing shortages in the number of nurses and nursing faculty, increased incidences of incivility, and the charge to transform nursing education while upholding and transmitting the core professional values, a better understanding of the climate within nursing education is warranted. Caring is a core value of the profession of nursing and has received much attention and study, primarily in the practice setting. In nursing education much of this work has centered on the structure and processes of nursing education and the nursing student’s development of caring behaviors. This article proposes a caring model for nursing education that integrates the key concepts of organizational climate, leadership, and caring theories. The intent of the model is to provide a framework that can be used for professional nursing education that incorporates the core value of caring and develops graduates prepared to provide relationship-based, patient-centered care.
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Rivaz M, Rakhshan M, Vizeshfar F, Setoodegan E. Validation of the Iranian Version of the Hospital Ethical Climate Survey. J Nurs Meas 2020; 28:JNM-D-18-00086. [PMID: 32179720 DOI: 10.1891/jnm-d-18-00086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to determine validation of the Iranian version of the Hospital Ethical Climate Survey (HECS). METHODS This is a methodological study with a cross-sectional design that was conducted in 2016. A forward-backward translation method was used to translate the questionnaire from English to Persian and face, content, and construct validity as well as reliability were assessed. RESULTS The factor structure of the HECS through explorative Principal Component Analysis (PCA) confirmed five factors that explained 64.7% of total variance. The overall Cronbach's alpha coefficient was .86 and the Cronbach's alphas for five of the subscales were between .63 and .92. CONCLUSIONS The Iranian version of HECS has adequate validity and reliability for measuring the hospital ethical climate in the Iraniansociety.
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Affiliation(s)
- Mozhgan Rivaz
- Shiraz University of Medical Sciences, Shiraz, Iran
- Iranian Social Security Organization, Shiraz, Iran
| | - Mahnaz Rakhshan
- Shiraz University of Medical Sciences, Shiraz, Iran
- Iranian Social Security Organization, Shiraz, Iran
| | - Fatemeh Vizeshfar
- Shiraz University of Medical Sciences, Shiraz, Iran
- Iranian Social Security Organization, Shiraz, Iran
| | - Elahe Setoodegan
- Shiraz University of Medical Sciences, Shiraz, Iran
- Iranian Social Security Organization, Shiraz, Iran
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Charalambous A, Cloconi C, Papastavrou E, Theodoula A. Psychometric Properties of the Hospital Ethical Climate Survey: A Cross-Sectional Study in Greek and Cypriot Cancer Care Settings. J Nurs Meas 2018; 26:237-248. [DOI: 10.1891/1061-3749.26.2.237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose:Ethical climate provides the context in which ethical behavior and decision-making occur. To test the psychometric properties of the Greek version of the Hospital Ethical Climate Survey (HECS) in cancer care settings.Methods:This was a cross-sectional study with 235 cancer nurses. Principal component analysis (PCA) and confirmatory factor analysis (CFA) were examined. Reliability was investigated with Cronbach’s coefficient α.Results:Cronbach’s α was 0.86 for the HECS total and ranged from 0.71 to 0.85 for the five subscales. PCA revealed that five components accounted for 61.09% of the variance which were comparable to those produced in the original validation study. The CFA with the five factors identified, produced a model with a good fit.Conclusion:The Greek version of the HECS is valid and reliable for use within the cancer care context.
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Constantina C, Papastavrou E, Charalambous A. Cancer nurses' perceptions of ethical climate in Greece and Cyprus. Nurs Ethics 2018; 26:1805-1821. [PMID: 29734886 DOI: 10.1177/0969733018769358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In recent years, the interest in ethical climate has increased in the literature. However, there is limited understanding of the phenomenon within the cancer care context as well as between countries. AIM To evaluate cancer nurses' perceptions of hospital ethical climate in Greece and Cyprus. RESEARCH DESIGN This was a quantitative descriptive-correlational comparative study with cancer nurses. Data were collected with the Greek version of the Hospital Ethical Climate Survey questionnaire in addition to demographic data. PARTICIPANTS AND RESEARCH CONTEXT In total, n = 235 cancer nurses working in cancer care settings in Greece and Cyprus were recruited at two national oncology nursing conferences. ETHICAL CONSIDERATIONS The study conforms to the principles of the World Medical Association Declaration of Helsinki and the relevant ethical approvals were obtained according to national law. RESULTS The results showed that in terms of the "Managers" dimension, participants working in Greek hospitals (4.30 ± 0.73) had a higher score compared to the Cyprus participants (3.66 ± 0.93) (t = -5.777, p ≤ 0.001). The perceptions of nurses working in oncology units in Greece regarding the ethical climate were more positive compared to Cyprus (M = 3.67 for Greece and M = 3.53 for Cyprus, p ≤ 0.001). Nurses with a higher level of education had a lower average ethical climate score across all dimensions. All dimensions exhibit positive and moderate to high correlations between them (r = 0.414-0.728, p < 0.01). CONCLUSION It is imperative to evaluate and improve the hospital ethical climate that prevails in each cancer care department. This highlights the fact that nurses working in seemingly similar cultural and organizational contexts might still have different perceptions of the ethical climate. Despite these differences, it is necessary to create the right conditions to address ethical issues. A positive ethical climate requires good relationships between healthcare professionals and the presence of good teamwork in order to ensure better healthcare provision.
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Koskenvuori J, Numminen O, Suhonen R. Ethical climate in nursing environment: A scoping review. Nurs Ethics 2017; 26:327-345. [DOI: 10.1177/0969733017712081] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: In the past two decades, interest in the concept of ethical climate and in its research has increased in healthcare. Ethical climate is viewed as a type of organizational work climate, and defined as the shared perception of ethically correct behavior, and how ethical issues should be handled in the organization. Ethical climate as an important element of nursing environment has been the focus of several studies. However, scoping reviews of ethical climate research in nursing have not been conducted to guide further research in this area. Objective: The purpose of this scoping review is to describe and analyze studies focusing on ethical climate in nursing environment to elicit an overall picture of the research in this field. Methods: A scoping review methodology guided by Arksey and O’Malley and Levac et al. was used. Studies were identified by conducting electronic searches on PubMed/MEDLINE, CINAHL, Web of Science Core Collection, PsycINFO, and Scopus and Philosophers’ Index databases. Of 1051 citations, 56 articles matched the inclusion criteria. Ethical considerations: This study was conducted according to good scientific guidelines. Findings: Ethical climate is a topical research area which has been explored with different methods and outcomes, in different environments, and has mainly been perceived positively. The focus of the studies was on finding associations between ethical climate and work-related factors such as job satisfaction, moral distress, and turnover intentions. Methodologically, research was rather homogeneous using quantitative, descriptive, and correlative research designs. Conclusion: Novel perspectives and more diverse methodological approaches paying attentions to issues affecting generalizability of the findings could expand our knowledge in this area.
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