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Rambod M, Pasyar N, Soltanian M. The predictive role of resilience and the ethical climate of hospital in the fatigue of surgical technologists working in operating rooms. BMC Psychol 2024; 12:380. [PMID: 38978098 PMCID: PMC11232221 DOI: 10.1186/s40359-024-01881-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Fatigue in surgical technologists is of paramount importance and is known as a priority because it can be regarded as a threat to the nurse's health and patient's safety. The fatigue level of healthcare workers can be affected by some factors, while the role of part of these factors is less known. This study aimed to determine the predictive role of resilience and the hospital ethical climate in the fatigue of surgical technologists working in operating rooms (ORs). METHODS This is a cross-sectional study conducted on 217 surgical technologists working in ORs of hospitals affiliated with Shiraz University of Medical Sciences. Data were collected using Connor-Davidson's Resilience scale, Olson's Hospital Ethical Climate Survey, and the Multidimensional Fatigue Inventory, and then analyzed using Pearson's correlation coefficient and multiple regression analysis. RESULTS 87.1% and 12.9% of surgical technologists reported low and high fatigue, respectively. All fatigue subscales had significant and negative relationships with resilience (p < 0.05). Moreover, the relationship between fatigue and ethical climate was significant (p = 0.02). The multiple linear regression model showed the predictive role of resilience in fatigue (β=-0.29, P < 0.001). According to the model, 10% of the change of fatigue was related to resilience and ethical climate. CONCLUSION The present study demonstrated the relationship between resilience and ethical climate with fatigue. Moreover, resilience was a predictor of the surgical technologists' fatigue, so that their fatigue decreased with increasing resilience. However, future studies are recommended to determine other factors influencing fatigue in surgical technologists.
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Affiliation(s)
- Masoume Rambod
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nilofar Pasyar
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Marzieh Soltanian
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Yu Q, Huang C, Yan J, Yue L, Tian Y, Yang J, Li X, Li Y, Qin Y. Ethical climate, moral resilience, and ethical competence of head nurses. Nurs Ethics 2024:9697330241230526. [PMID: 38317573 DOI: 10.1177/09697330241230526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND The ethical competence of head nurses plays a pivotal role in nursing ethics. Ethical climate is a prerequisite for ethical competence, and moral resilience can positively influence an individual's ethical competence. However, few studies have focused on the relationship between ethical climate, moral resilience, and ethical competence among them. OBJECTIVES To investigate the relationship between ethical climate, moral resilience, and ethical competence, and examine the mediating role of moral resilience between ethical climate and ethical competence among head nurses. DESIGN A quantitative, cross-sectional study. METHODS A total of 309 Chinese head nurses completed an online survey, including ethical climate questionnaire, Rushton moral resilience scale, and ethical competence questionnaire. Inferential statistical analysis includes Pearson's correlation and a structural equation model. ETHICAL CONSIDERATIONS This study received ethical approval from the Institutional Review Board of Xiangya Nursing School of Central South University (No. E2023146). RESULTS Head nurses' ethical climate score positively impacted ethical competence (r = 0.208, p < .001), and ethical climate could affect ethical competence through the mediating role of moral resilience. CONCLUSION This study emphasized the value of ethical climate in moral resilience of head nurses, ultimately leading to an enhancement in their ethical competence.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yuelan Qin
- The First Affiliated Hospital of Hunan Normal University
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Khajehpour M, Keramat A, Balouchi Mahani M, Shahinfar S. Ethical Climate in the Delivery Wards of Educational Hospitals in Southeast Iran. Policy Polit Nurs Pract 2024; 25:29-35. [PMID: 38087397 DOI: 10.1177/15271544231214527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Ethical climate is one of the important factors in the working climate of the hospital. Considering the difference in the Ethical climate in different departments of the hospital and the importance of the ethical climate in the delivery ward, this study aimed to assess the characteristics of hospital ethical climate in delivery ward of educational hospitals in southeast Iran. This descriptive and multi-center study was conducted from 2020 to 2021 in educational hospitals in southeast Iran. Two hundred forty midwives working in delivery wards, midwifery instructors, and midwifery students were included in the study by census method. Data collection tools included a demographic information form, Olson's Hospital Ethical Climate Survey, completed using the self-report method. The mean ethical climate in the midwifery group (3.82 ± 0.63 out of 5) was higher than in the instructors' and students' groups. The lowest mean score obtained from the ethical climate questionnaire of participants was associated with the inability to use their experiences in the delivery ward. The lowest mean of ethical climate from the midwives' point of view is the Physicians' dimension and the patient's dimension from the instructors' point of view. The highest mean score belonged to the ethical climate of the supervisors. According to the results of the present study, it is suggested to implement protective laws to support the higher independence of midwives to improve the ethical climates by using their experiences in the delivery department.
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Affiliation(s)
- Mahin Khajehpour
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Afsaneh Keramat
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mahin Balouchi Mahani
- Department of Midwifery, School of Nursing and Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Sholeh Shahinfar
- Department of Midwifery, Kerman Branch, Islamic Azad University, Kerman, Iran
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Noh YG, Kim SY. Factors of Hospital Ethical Climate among Hospital Nurses in Korea: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:372. [PMID: 38338257 PMCID: PMC10855336 DOI: 10.3390/healthcare12030372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
In the current healthcare landscape, nurses frequently encounter various ethical dilemmas, necessitating situation-specific ethical judgments. It is crucial to thoroughly understand the factors that shape the hospital ethical climate and the elements that are influenced by this climate. This study aims to identify the variables associated with the hospital ethical climate perceived by Korean nurses. A literature search was conducted using the core database, and the effect sizes of relevant variables were analyzed using a comprehensive meta-analysis. The overall effect size analysis incorporated 56 variables, and a meta-analysis was performed on 7 variables. This study found correlations between ethical sensitivity (ESr = 0.48), moral distress (ESr = -0.30), empathy (ESr = 0.27), ethical leadership (ESr = 0.72), job satisfaction (ESr = 0.64), and intention to leave (ESr = -0.34) with the hospital ethical climate. Both personal and organizational attributes were moderately related to the hospital ethical climate. Enhancing the hospital ethical climate could positively affect both individuals and the organization. The protocol for this study has been registered with PROSPERO (CRD42022379812).
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Affiliation(s)
| | - Se Young Kim
- Department of Nursing, Changwon National University, Changwon 51140, Republic of Korea;
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Noh YG, Kim SY. Factors of hospital ethical climate among hospital nurses in Korea: a protocol for systematic review and meta-analysis. BMJ Open 2024; 14:e078102. [PMID: 38262648 PMCID: PMC10806629 DOI: 10.1136/bmjopen-2023-078102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION The hospital ethical climate refers to the ethical work environment within a hospital, which may positively or negatively impact individual nurses, nursing organisations and patient care. Most of studies investigating the hospital ethical climate among Korean nurses have been published in Korean. However, papers addressing the hospital ethical climate in Korean were excluded from the systematic review. To enhance our comprehension of the hospital ethical climate, a systematic review specifically focusing on Korean nurses is imperative. Additionally, it is crucial to ascertain the factors associated with the hospital ethical climate and their respective effect sizes through meta-analyses. METHODS AND ANALYSIS The systematic search will be conducted for papers published in both Korean and English, encompassing the hospital ethics climate of Korean nurses from 10 database inception to May 2023. Two reviewers will independently review each article based on the inclusion and exclusion criteria, and any differences in opinion will be resolved through discussion and consensus. The study selection process will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Quality assessment will be conducted using the Checklist for Analytical Cross-Sectional Studies provided by Joanna Briggs Institute. Effect size will be analysed using Comprehensive Meta-Analysis software V.2.0. The results of this study will identify factors related to the hospital ethical climate and the effect size of these factors among nurses in Korea. ETHICS AND DISSEMINATION Ethical approval is not required, as the data will be collected from existing literature. Findings will be disseminated through peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022379812.
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Affiliation(s)
- Yoon Goo Noh
- Department of Nursing, Changwon National University, Changwon, Korea (the Republic of)
| | - Se Young Kim
- Department of Nursing, Changwon National University, Changwon, Korea (the Republic of)
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Tang FWK, Ng MSN, Choi KC, Ling GCC, So WKW, Chair SY. Impacts of ethical climate and ethical sensitivity on caring efficacy. Nurs Ethics 2023:9697330231222595. [PMID: 38155364 DOI: 10.1177/09697330231222595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
BACKGROUND Caring practice begins with awareness of the suffering of patients in a given context. Understanding the interrelationship between the perceived ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses is crucial for strengthening the caring competency of nurses. RESEARCH AIM This study aimed to examine the associations between the ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses and to investigate the mediating effect of ethical sensitivity on the association between ethical climate and caring efficacy. RESEARCH DESIGN This was a quantitative study with a cross-sectional descriptive correlational design. The participants completed an online survey that measured the ethical climate, ethical sensitivity and caring efficacy using the Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire-Revised and Caring Efficacy Scale, respectively. PARTICIPANTS AND RESEARCH CONTEXT The study recruited 293 nurses from two general hospitals that provided acute in-patient and extended care in Hong Kong. ETHICAL CONSIDERATIONS Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. RESULTS Ethical climate was associated with caring efficacy (β = 0.340, p < .001) and ethical sensitivity (β = 0.197, p < .001). After adjusting for ethical climate, ethical sensitivity was associated with caring efficacy (β = 0.860, p < .001). Ethical sensitivity showed a significant mediating effect on the association between ethical climate and caring efficacy (indirect effect = 0.169, 95% confidence interval: 0.097 to 0.261), which accounted for 50% of the total effect. CONCLUSIONS The study reveals the complex and interwoven relationship between contextual and personal factors that affect nurses' caring efficacy from an ethical perspective. It provides insights into the significant roles of ethical climate and ethical sensitivity in strengthening caring efficacy. The results suggest theoretical and clinical implications for professionalisation.
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Morley G, Sankary LR. Nurturing moral community: A novel moral distress peer support navigator tool. Nurs Ethics 2023:9697330231221220. [PMID: 38149497 DOI: 10.1177/09697330231221220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Moral distress is a pervasive phenomenon in healthcare for which there is no straightforward "solution." Rhetoric surrounding moral distress has shifted over time, with some scholars arguing that moral distress needs to be remedied, resolved, and eradicated, while others recognize that moral distress can have some positive value. The authors of this paper recognize that moral distress has value in its function as a warning sign, signaling the presence of an ethical issue related to patient care that requires deeper exploration, rather than evidencing identification of the "right" course of action. Once the experience of moral distress is identified, steps ought to be taken to clarify the moral issue, and, if possible and reasonable, the patient's values ought to be prioritized. This paper offers concrete actions steps, drawn from theory, which can be used in clinical practice to provide peer support or to facilitate self-reflection for morally distressed individuals. This approach empowers morally distressed individuals to explore ethical issues, identify concrete steps that can be taken, and mitigate feelings of powerlessness that are often associated with moral-constraint distress. The questions guide individuals and peers to reflect first on the micro-space and then more broadly on the institutional culture, facilitating meso- and macro-reflection and action.
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Affiliation(s)
- Georgina Morley
- Nursing Ethics Program, Center for Bioethics, Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic Health System
| | - Lauren R Sankary
- Neuroethics Program, Center for Bioethics, Neurological Institute, Cleveland Clinic Health System
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Maisonneuve F, Groulx P, Chênevert D, Grady C, Coderre-Ball A. Effects of ethical climate in association with tenure on work addiction, quality of care and staff retention: a cross-sectional study. BMJ Qual Saf 2023; 33:24-32. [PMID: 37193593 DOI: 10.1136/bmjqs-2022-015824] [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] [Received: 12/06/2022] [Accepted: 04/29/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Work addiction is not contingent on personality alone; it is also impacted by social contextual factors. Work addiction influences the perceived quality of care and intention to remain in healthcare sector. The current study seeks to understand the role of ethical climate as a potential organisational lever to reduce such addiction, especially among newcomers. DESIGN We contacted a sample of Canadian healthcare organisations to collect quantitative data using an online questionnaire from November 2021 to February 2022. All constructs (ethical climate, work addiction, perceived quality of care, intention to quit the profession) were measured using validated psychometric scales. 860 respondents provided complete questionnaires. We analysed the data using structural equation modelling and regression analysis. RESULTS Work addiction mediated the indirect relationship between ethical climate and the intention to quit the profession (β=-0.053; 95% CI (-0.083 to -0.029); p<0.001) and with quality of care (β=0.049; 95% CI (0.028, 0.077); p<0.001). For each increase of 1 SD of ethical climate, the total effects regarding the variations in the outcomes were more important at low rather than high levels of tenure for work addiction (-11%, -2%), perceived quality of care (23%, 11%) and intention to quit the profession (-30%, -23%), respectively. CONCLUSION Ethical climate in healthcare organisations has a significant and beneficial relationship with healthcare workers' (HCWs) work addiction behaviours. In turn, this relationship is related to greater perceived quality of care and higher intention to remain, especially for HCWs with lower tenure.
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Affiliation(s)
| | | | - Denis Chênevert
- Human Resource Management, HEC Montreal, Montreal, Quebec, Canada
| | - Colleen Grady
- Family Medecine, Queen's University, Kingston, Ontario, Canada
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Peter E, Mohammed S, Boakye P, Rose D, Killackey T. Registered Practical Nurses' Experiences of the Moral Habitability of Long-Term Care Environments during the COVID-19 Pandemic. Can J Aging 2023; 42:719-727. [PMID: 37721011 DOI: 10.1017/s0714980823000491] [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: 09/19/2023] Open
Abstract
The COVID-19 pandemic has had a deleterious impact on the lives of nurses who work in long-term care; however, the moral conditions of their work have been largely unexamined. The purpose of this qualitative study, therefore, was to explore registered practical nurses' (RPNs) experiences of the moral habitability of long-term care environments in Ontario, Canada during the COVID-19 pandemic. Four themes were identified: (1) Striving to meet responsibilities in a failed system; (2) bearing the moral and emotional weight of residents' isolation and dying in a context of strict public health measures; (3) knowing the realities of the work, yet failing to be heard, recognized, or supported by management; and (4) struggling to find a means of preservation for themselves and the profession. Attention to the moral habitability of RPNs' work environments is necessary to achieve a high-quality, ethically attuned, and sustainable nursing workforce in long-term care.
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Affiliation(s)
- Elizabeth Peter
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Shan Mohammed
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Priscilla Boakye
- Daphne Cockwell School of Nursing, Toronto Metropolitan University Toronto, ON, Canada
| | - Donald Rose
- Daphne Cockwell School of Nursing, Toronto Metropolitan University Toronto, ON, Canada
| | - Tieghan Killackey
- School of Nursing, York University, Health, Nursing and Environmental Studies, Toronto, ON, Canada
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Liu Y, Ying L, Zhang Y, Jin J. The experiences of intensive care nurses coping with ethical conflict: a qualitative descriptive study. BMC Nurs 2023; 22:449. [PMID: 38037055 PMCID: PMC10687825 DOI: 10.1186/s12912-023-01612-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The critical conditions and life risk scenarios make intensive care nurses susceptible to ethical conflict. Negative consequences were recognized at both the individual level and the professional level which highly compromised the patient care and nurses' well-being. Therefore, ethical conflict has become a major concern in nursing practice. However, the experience of coping with ethical conflict among intensive care nurses remains unclear. AIMS This study aims to explore the experience of intensive care nurses coping with ethical conflict in China. METHODS From December 2021 to February 2022, in- depth interviews with 15 intensive care nurses from five intensive care units in a tertiary general hospital in China was performed using purposive sampling. An inductive thematic analysis approach was used to analyze the data. We applied the consolidated criteria for reporting qualitative research for this study. RESULTS Two distinctive themes were found: detachment and engagement, which contained four subthemes: ignoring ethical problems in the workplace, seeking ways to express emotions, perspective-taking, and identifying positive assets. Theses coping strategies demonstrated an ongoing process with different essential features. CONCLUSION This study provides a new insight into the experience of intensive care nurses coping with ethical conflict in clinical nursing. Intensive care nurses demonstrated differential experience of coping with ethical conflict including problem-focused, emotion-focused and meaning-making strategies. These findings have implications for policymakers and nursing administrators to develop ethical education and training and supportive environment for intensive care nurses to tackle this issue.
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Affiliation(s)
- Yuanfei Liu
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Zhejiang University, Hangzhou, China
| | - Liying Ying
- Department of Nursing, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuping Zhang
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Zhejiang University, Hangzhou, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Zhejiang University, Hangzhou, China.
- Changxing Branch Hospital of SAHZU, No.66 Taihu middle road, Changxing Country, Huzhou, 313100, Zhejiang, China.
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China.
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Lanes TC, Dalmolin GDL, Silva AMD, Bernardi CMS, Schutz TC, Tiguman GMB. Influence of the ethical climate on workers' health among healthcare professionals: a systematic review. Rev Gaucha Enferm 2023; 44:e20220247. [PMID: 37909511 DOI: 10.1590/1983-1447.2023.20220247.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 05/30/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE To evaluate the influence of the ethical climate on workers' health among healthcare professionals. METHOD Systematic review and meta-analysis conducted in MEDLINE/PubMed, EMBASE, SciVerse Scopus (Elsevier), Cumulative Index to Nursing and Allied Health Literature and Web of Science. Trained reviewers performed the selection, data extraction, and assessment of methodological quality. Meta-analysis was applied for data synthesis. RESULTS Among the 2644 studies, 20 were included for analysis, in which three (15.0%) articles were classified as high quality (score ≥ 80%), while 17 (85.0%) were classified as regular (score 50-79%). There was a moderate negative correlation between the ethical climate and overall moral distress (r=-0.43; 95%CI -0.50; -0.36) and the frequency of moral distress (r=-0.36; 95%CI -0.45; -0.25), as well as the positive and strong correlation between ethical climate and job satisfaction (r=0.71; 95%CI 0.39-0.88). CONCLUSION The negative and positive perception of the ethical climate among healthcare professionals, respectively, influenced the increase in moral distress and job satisfaction.
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Affiliation(s)
- Taís Carpes Lanes
- Universidade Federal de Santa Maria (UFSM). Programa de Pós-Graduação em Enfermagem. Santa Maria, Rio Grande do Sul, Brasil
| | - Graziele de Lima Dalmolin
- Universidade Federal de Santa Maria (UFSM). Departamento de Enfermagem. Santa Maria, Rio Grande do Sul, Brasil
| | - Augusto Maciel da Silva
- Universidade Federal de Santa Maria (UFSM). Departamento de Estatística. Santa Maria, Rio Grande do Sul, Brasil
| | - Camila Milene Soares Bernardi
- Universidade Federal de Santa Maria (UFSM). Programa de Pós-Graduação em Enfermagem. Santa Maria, Rio Grande do Sul, Brasil
| | - Thaís Costa Schutz
- Universidade Federal de Santa Maria (UFSM). Programa de Pós-Graduação em Enfermagem. Santa Maria, Rio Grande do Sul, Brasil
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Gurdap Z, Cengiz Z. Compassion Fatigue and Ethical Attitudes in Nursing Care in Intensive Care Nurses During the COVID-19 Pandemic: A Cross-sectional Study. J Nurs Care Qual 2023; 38:312-318. [PMID: 36917830 DOI: 10.1097/ncq.0000000000000702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Intensive care unit (ICU) nurses faced an increased risk of compassion fatigue and ethical concerns during the COVID-19 pandemic. PURPOSE To evaluate compassion fatigue of ICU nurses and their ethical attitudes in care during the COVID-19 pandemic and analyze contributing factors. METHODS An exploratory cross-sectional research design was used. RESULTS A total of 103 ICU nurses participated. The nurses' compassion fatigue and ethical attitude scores were high. Compassion fatigue was explained by the following variables: considering resigning, receiving support for ethical decisions, willingness to work in the ICU, duration of providing activities of daily living in a shift, and number of patients per nurse. CONCLUSIONS Compassion fatigue was high in nurses working in the ICU during COVID-19. The high level of ethical attitudes shows commitment to professional ethics and reflects the development of the nurses' professional identity. Implementation of interventions that help improve compassion fatigue among nurses is needed.
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Affiliation(s)
- Zuleyha Gurdap
- Department of Fundamentals of Nursing, Nursing Faculty, Inonu University, Malatya, Turkey
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Wang L, Dong X, An Y, Chen C, Eckert M, Sharplin G, Fish J, Fan X. Relationships between job burnout, ethical climate and organizational citizenship behaviour among registered nurses: A cross-sectional study. Int J Nurs Pract 2023; 29:e13115. [PMID: 36285488 DOI: 10.1111/ijn.13115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 07/31/2022] [Accepted: 10/01/2022] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to investigate the levels of nurses' organizational citizenship behaviour and the associations between job burnout and ethical climate with organizational citizenship behaviour. BACKGROUND Organizational citizenship behaviour improves adverse outcomes led by nursing shortage. However, the associations between three dimensions of job burnout and organizational citizenship behaviour are inconsistent, and little is known about whether ethical climate is related to organizational citizenship behaviour in nurses. METHODS In this cross-sectional study, 1157 nurses were selected using convenience sampling from April to October 2019. Self-report surveys assessed nurses' organizational citizenship behaviour, emotional exhaustion, depersonalization, personal accomplishment and perceptions of ethical climate. RESULTS Mean organizational citizenship behaviour was high among nurses. The regression model showed that job burnout and ethical climate explained an additional 38.6% of the variance in organizational citizenship behaviour over and above sociodemographic factors, with 44.9% of the total variance. CONCLUSION Nurses' organizational citizenship behaviour was at a relatively high level. Depersonalization was negatively associated with organizational citizenship behaviour while personal accomplishment and ethical climate were positively related to organizational citizenship behaviour. Therefore, nurse leaders are encouraged to take measures to help nurses reduce job burnout and create a favourable ethical climate for increasing nurses' organizational citizenship behaviour.
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Affiliation(s)
- Lyu Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoyu Dong
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yan An
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Cancan Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Greg Sharplin
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jennifer Fish
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Xiuzhen Fan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
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Sillero Sillero A, Ayuso Margañon R, Moreno-Segura N, Carrasco JJ, Atef H, Ayuso Margañon S, Marques-Sule E. Physiotherapists' Ethical Climate and Work Satisfaction: A STROBE-Compliant Cross-Sectional Study. Healthcare (Basel) 2023; 11:2631. [PMID: 37830668 PMCID: PMC10572859 DOI: 10.3390/healthcare11192631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
(1) Background: This study aimed to examine the relationship between Spanish physical therapists' perceptions of the ethical climate, their moral sensitivity (awareness of ethical issues), and job satisfaction. (2) Methods: the study analyzed descriptive correlational data on 104 physical therapists from three Spanish metropolitan hospitals. Respondents completed a demographic data form, an ethical climate questionnaire, a job satisfaction survey, and a moral sensitivity scale. This study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. (3) Results: With a mean score of 4.2, physical therapists are typically content with their jobs. The mean scores for the moral sensitivity and ethical climate questionnaires are high, at 40.1 (SD 6.3) and 96.8 (SD 17.1), respectively. There is a significant positive correlation between job satisfaction and ethical climate (r between 0.59 and 0.79) but only a weak correlation between job satisfaction and moral sensibility (r between 0 and 0.32 for the three aspects measured). (4) Conclusions: Generally speaking, physical therapists reported that they had high job satisfaction, a positive workplace environment, and excellent management support. Despite a weak relationship with moral sensibility, there is a strong association between ethical behavior, hospital organization, and higher levels of job satisfaction. It is important to encourage the development of moral sensibilities to boost psychological well-being and therapeutic decision-making.
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Affiliation(s)
- Amalia Sillero Sillero
- Mar Nursing School (ESIMar), Parc de Salut Mar, University Pompeu Fabra Affiliated, 08003 Barcelona, Spain
- Social Determinants and Health Education Research Group (SDHEd), Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Raquel Ayuso Margañon
- Mar Nursing School (ESIMar), Parc de Salut Mar, University Pompeu Fabra Affiliated, 08003 Barcelona, Spain
- Social Determinants and Health Education Research Group (SDHEd), Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Noemí Moreno-Segura
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Juan J Carrasco
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Intelligent Data Analysis Laboratory, University of Valencia, 46100 Valencia, Spain
| | - Hady Atef
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Staffordshire ST5 5BG, UK
- Department of Physical Therapy for Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University, Cairo 11432, Egypt
| | - Sonia Ayuso Margañon
- Department of Public Health Nursing, Mental Health and Perinatal Nursing, Faculty of Medicine and Health Sciences, 08907 Barcelona, Spain
| | - Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
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Amos V, Phair N, Sullivan K, Wocial LD, Epstein B. A Novel Web-Based and Mobile Application to Measure Real-Time Moral Distress: An Initial Pilot and Feasibility Study. Jt Comm J Qual Patient Saf 2023; 49:494-501. [PMID: 37336696 DOI: 10.1016/j.jcjq.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023]
Abstract
PROBLEM DEFINITION Moral distress (MoD) is a vital clinical indicator linked to clinician burnout and provider concerns about declining patient care quality. Yet it is not routinely assessed. Earlier, real-time recognition may better target interventions aimed at alleviating MoD and thereby increase provider well-being and improve patient care quality. INITIAL APPROACH AND TESTING Combining two validated MoD instruments (the Moral Distress Thermometer [MDT] and the Measure of Moral Distress for Healthcare Professionals [MMD-HP]), the authors developed a novel mobile and Web-based application environment to measure and report levels MoD and their associated causes. This app was tested for basic feasibility and acceptability in two groups: graduate nursing students and practicing critical care nurses. RESULTS The MDT app appears feasible and acceptable for future use. All participants (n = 34) indicated the MDT app was satisfying to use, and 91.2% (n = 31) indicated the app was "very appropriate" for measuring MoD. In addition, 84.2% (n =16) of practicing nurses indicated the app fit either "somewhat well" (47.4%, n = 9) or "very well" (36.8%, n = 7) into their typical workday, and 68.4% (n = 13) said they were either "extremely likely" or "somewhat likely" to use the app daily in clinical practice. KEY INSIGHTS AND NEXT STEPS Education about moral distress and its associated causes proved important to the MDT app's success. It is ready for future validity and reliability testing, as well as examining usability beyond nursing, longitudinal data monitoring, and possible leveraging to pre- and postintervention evaluation studies.
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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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17
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Abstract
BACKGROUND Hospital ethical climate has important implications for clinical nurses' service behavior; however, the relationships are complicated by the fact that five types of ethical climate (caring, law and code, rules, instrumental, and independence) can be combined differently according to their level and shape differences. Recent developments in person-centered methods (e.g., latent profile analysis (LPA)) have helped to address these complexities. AIM From a person-centered perspective, this study explored the distinct profiles of hospital ethical climate and then examined the relationships of the profiles with clinical nurses' service behavior (both in-role and extra-role service behavior). RESEARCH DESIGN A quantitative study was conducted using cluster random sampling. Latent profile analysis and binary coded hexadecimal (BCH) analysis were conducted using Mplus 8.2. PARTICIPANTS AND RESEARCH CONTEXT A total of 871 clinical nurses in China were surveyed using the Ethical Climate Scale and Nurses' Service Behavior Questionnaire. ETHICAL CONSIDERATIONS Ethical approval was obtained from the IRB of the First Affiliated Hospital of Jinan University (No. KY-2020-090). RESULTS A four-profile hospital ethical climate model provided the best fit for the data. The four different profiles not only varied in level, but also in shape: high normative and low egoism (45.8%), high ethical climate (19.9%), low ethical climate (3.6%), and moderate ethical climate (30.8%). These profiles differentially predicted clinical nurses' overall, in-role, and extra-role service behaviors. CONCLUSIONS The results reveal new insights into the nature of hospital ethical climate and how different clinical nurses in these profiles can be best managed to accomplish different forms of service behavior.
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Affiliation(s)
- Na Zhang
- Beijing Information Science and Technology University, China
| | | | - Xing Bu
- University of Science and Technology Beijing, China
| | - Zhen Xu
- Hebei University of Engineering, China
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18
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Wöhlke S, Riedel A. [Nursing ethics and the mandate of care-current limits using the example of inpatient care for the elderly]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:508-514. [PMID: 37085589 PMCID: PMC10121069 DOI: 10.1007/s00103-023-03696-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/29/2023] [Indexed: 04/23/2023]
Abstract
The central guiding ethical principles of professional care are dignity, care, justice, and respect. The current framework conditions and circumstances in the care of the elderly mean that professional care ethics are no longer feasible in many cases. This leads not only to enormous (moral) burdens among the nursing staff, but also to a comprehensive degree to professional dissatisfaction and to leaving the profession. The term "Pflexit" (based on the German word "Pflege" = care) was first raised during the corona pandemic and has not faded. In order to ensure ethically justified and dignified care for the elderly that is also oriented towards human rights, as is conveyed politically in charters and rightly expected by people in need of care, rapid and comprehensive social and political intervention is required.In this context, dignity and respect are also a social mandate. Dignified professional care based on ethical values can only be implemented if nurses are shown this same respect. The clear warnings of a "nursing climate crisis" must finally be followed by action to stop the exodus from the profession. In this discussion paper, the importance of a professional care ethic is first explained. In a second step, the framework and current problems that oppose a comprehensive implementation of core values in nursing care for the elderly are highlighted. The focus here is on the effects of the precarious personnel situation.
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Affiliation(s)
- Sabine Wöhlke
- Gesundheitswissenschaften und Ethik, Fakultät Life Science, Hochschule für Angewandte Wissenschaften Hamburg, Campus Bergedorf, Ulmenliet 20, 21033, Hamburg, Deutschland.
| | - Annette Riedel
- Soziale Arbeit, Bildung und Pflege, Hochschule Esslingen, Esslingen, Deutschland
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19
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Kim H, Kim H, Oh Y. Impact of ethical climate, moral distress, and moral sensitivity on turnover intention among haemodialysis nurses: a cross-sectional study. BMC Nurs 2023; 22:55. [PMID: 36842970 PMCID: PMC9969632 DOI: 10.1186/s12912-023-01212-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/17/2023] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND While several studies have been performed on turnover intention among nurses, limited studies have considered the ethical perspectives on turnover intention among haemodialysis nurses. The purpose of this study was to clarify the impact of ethical factors, namely ethical climate, moral distress, and moral sensitivity on turnover intention among haemodialysis nurses. METHODS This cross-sectional research was conducted between July and August 2017. A total of 148 haemodialysis nurses were invited to participate in the study by convenience sampling from 11 general and university hospitals in South Korea. Data were analysed using SPSS for t-test, one-way analysis of variance, Pearson's correlation coefficients, and multiple regression analysis. RESULTS In the final regression model, the adjusted R-squared significantly explained 34.6% of the variance in turnover intention (F = 22.534, p < .001) when moral distress related to physician practice (β = 0.310, p = .001) and ethical climate related to the hospital climate (β = - 0.253, p = .003) and manager (β = - 0.191, p = .024) were included. Following the stepwise multiple regression process, all subdomains related to moral sensitivity were excluded due to no statistical significance in the final regression model. CONCLUSION To reduce turnover intention among haemodialysis nurses, hospitals and managers should pay attention to haemodialysis nurses' moral distress originating from physicians' practice and improve their ethical climate. Additionally, it is required that the impact of moral sensitivity on turnover among nurses working in diverse care settings be examined further.
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Affiliation(s)
- Haengsuk Kim
- grid.256753.00000 0004 0470 5964Graduate School of Nursing Science, Hallym University, Hallymdaehakgil 1, 24252 Chuncheon, Gangwon-do Republic of Korea ,grid.488451.40000 0004 0570 3602Kangdong Sacred Heart Hospital, Seongan-ro 150, Gangdong-gu, 05355 Seoul, Republic of Korea
| | - Hyunjung Kim
- grid.256753.00000 0004 0470 5964College of Nursing, Research Institute of Nursing Science, Hallym University, Hallymdaehakgil 1, 24252 Chuncheon, Gangwon-do Republic of Korea
| | - Younjae Oh
- College of Nursing, Research Institute of Nursing Science, Hallym University, Hallymdaehakgil 1, 24252, Chuncheon, Gangwon-do, Republic of Korea.
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Diaz PDS, Barth PO, Silva MPD, Ferreira DS, Brehmer LCDF, Brito MJM, Dalmolin GDL, Ramos FRS. Gestão e ambientes de trabalho na atenção primária à saúde. REME: REVISTA MINEIRA DE ENFERMAGEM 2022. [DOI: 10.35699/2316-9389.2022.40472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Objetivo: identificar subsídios teóricos e empíricos sobre ambientes de trabalho na APS em sua relação a saúde do trabalhador (questão preliminar) que indiquem elementos relativos à gestão (questão específica). Métodos: Scoping Review de seis etapas com consulta aos sujeitos, busca na literatura no período de 2010 a 2019 em seis bases de dados e bibliotecas virtuais com seleção de 21 artigos. A etapa complementar, de consulta, operacionalizou grupo focal com 14 trabalhadores da Atenção Primária à Saúde em um município do Sul do Brasil. Resultados: organizados em três categorias temáticas: Aspectos administrativos no ambiente de trabalho: dificuldades relacionadas à gestão; Percepções sobre as relações de trabalho: barreiras entre equipe e gestão; Conflitos no ambiente de trabalho: estratégias de enfrentamento. Considerações finais: questões de ordem burocrática e de rotina da APS influenciam as relações interpessoais e os resultados alcançados, sendo fundamentais para o alcance de ambientes saudáveis de trabalho dos atores em cena. O suporte institucional, o diálogo e a possibilidade em exercer um trabalho pleno de sentido e valor é direito do trabalhador, reafirmando a promoção de ambientes de trabalho saudáveis na APS como prioridade ético-política.
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Maffoni M, Sommovigo V, Giardini A, Velutti L, Setti I. Well-Being and Professional Efficacy Among Health Care Professionals: The Role of Resilience Through the Mediation of Ethical Vision of Patient Care and the Moderation of Managerial Support. Eval Health Prof 2022; 45:381-396. [PMID: 34530627 DOI: 10.1177/01632787211042660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Drawing on the Conservation of Resources theory, this study analyzes whether resilience could be related to healthcare providers' wellbeing and professional self-efficacy, both directly and indirectly, as mediated by ethical vision of patient care and moderated by managerial support in dealing with ethical issues. Overall, 315 Italian healthcare professionals employed in neuro-rehabilitation medicine or palliative care specialties participated in this multi-centered cross-sectional study. The following variables were investigated: resilience (Connor-Davidson Resilience Scale), wellbeing (Maugeri Stress Index-Reduced), professional self-efficacy (Maslach Burnout Inventory-General Survey), ethical vision of patient care and managerial support in dealing with ethical issues (Italian version of the Hospital Ethical Climate Survey). Overall, resilience was positively associated with healthcare providers' wellbeing and professional self-efficacy, directly and indirectly, as mediated by ethical vision of patient care. Highly resilient healthcare professionals who perceived the presence of a positive ethical vision of patient care in their workplace were more likely to experience greater wellbeing when managerial support in dealing with ethical issues was high (vs. low). Thus, these findings provide suggestions for tailored interventions sustaining healthcare professionals along their daily activity characterized by high-demanding and challenging situations.
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Affiliation(s)
- Marina Maffoni
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Montescano Institute (Pavia), Italy
| | - Valentina Sommovigo
- Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia, Italy
| | - Anna Giardini
- IT Department, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Laura Velutti
- Medical Oncology and Hematology Unit, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Ilaria Setti
- Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia, Italy
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22
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Liu Y, Wang X, Wang Z, Zhang Y, Jin J. Ethical conflict in nursing: A concept analysis. J Clin Nurs 2022. [DOI: 10.1111/jocn.16563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/05/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Yuanfei Liu
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU) Zhejiang University Hangzhou China
| | - Xueqing Wang
- Department of Nursing, Sir Run Run Shaw Hospital Zhejiang University School of Medicine Zhejiang University Hangzhou China
| | - Zhaochen Wang
- School of Public Health, School of Medicine Zhejiang University Hangzhou China
| | - Yuping Zhang
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU) Zhejiang University Hangzhou China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU) Zhejiang University Hangzhou China
- Changxing Branch Hospital of SAHZU Huzhou China
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province Hangzhou China
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23
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Okumoto A, Yoneyama S, Miyata C, Kinoshita A. The relationship between hospital ethical climate and continuing education in nursing ethics. PLoS One 2022; 17:e0269034. [PMID: 35862376 PMCID: PMC9302802 DOI: 10.1371/journal.pone.0269034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
Background In recent years, there has been a growing interest in the importance of creating a healthy ethical climate. Although relationship with various factors and the ethical climate have been reported, understanding of the relationship between ethical education and ethical climate is limited. Aim This study aims to investigate the relationship between ethical climate, personal characteristics, and continuing education for ethics. Methods This study conducted a quantitative cross-sectional survey of 605 nurses in 3 teaching hospitals in Japan. Multiple-regression analysis was used to assess the relationship between ethical climate and demographic characteristics and continuing education. Further mean of ethical climate scores were compared between received continuing education and did not, using analysis of covariance adjusted for demographic variables. Findings The ethical climate showed significant association with hospital, gender, specialty of the unit, experience of ethics education, in-service ethical training, and workshops/ academic conferences on nursing ethics. In multiple-regression analysis, attending in-service ethical training increased the mean of ethical climate score (p = 0.031) and workshops/ academic conferences decreased the mean score (p = 0.028). Adjusted-mean of ethical climate score of nurses who had in-service training was significantly higher than those who had not (p = 0.038), whereas adjusted-mean of it of nurses who had attended workshops/ academic conferences was significant lower (p = 0.033). Discussion In-service training on ethics was associated with the positive ethical climate. Hospital should enhance ethical education. Conclusion Ethical climate related to the nurses’ personal characteristics and continuing education. We propose that organizational support for ethical education may be effective in raising the ethical climate of the workplace.
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Affiliation(s)
- Ayaka Okumoto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- * E-mail:
| | - Satoko Yoneyama
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Chiharu Miyata
- Course of nursing science, Mie University Graduate School of Medicine, Mie, Japan
| | - Ayae Kinoshita
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Kim S, Jeong SH, Seo MH. Nurses' ethical leadership and related outcome variables: Systematic Review and Meta-analysis. J Nurs Manag 2022; 30:2308-2323. [PMID: 35761760 DOI: 10.1111/jonm.13726] [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: 03/27/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022]
Abstract
AIM To investigate the outcomes and the effect sizes of ethical leadership in nursing practice BACKGROUND: Many meta-analysis of ethical leadership have conducted in other fields, but there are none of the effects of ethical leadership of nurse leaders and should be investigated EVALUATION: For a systematic literature review, we searched PubMed, EMBASE, the Cochrane Library, CINAHL, OVID, Web of Science, and Korean databases for studies published in Korean or English. We used CMA 2.0 and R 3.6.2 for the meta-analysis KEY ISSUES: We divided the outcomes of ethical leadership into three categories and investigated the effect sizes: subordinates' perceptions of their leaders (ES = 0.65), subordinates' ethical behaviors (ES = 0.04), and job or organizational outcomes (ES = 0.45). In addition, we identified 14 outcome variables, and transformational leadership showed the greatest effect size (ES = 0.77) among them CONCLUSION: This study confirmed the positive effects of ethical nursing leadership on individual nurses' perceptions about their leaders, their jobs, and organizations IMPLICATIONS FOR NURSING MANAGEMENT: Nursing organizations and nurse administrators should make efforts to highlight ethical leadership of nurse leaders to improve outcomes of organizational performance including individual nurses' perceptions about their leaders, their jobs, and organizations.
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Affiliation(s)
- Sunmi Kim
- College of Nursing, Jeonbuk National University, Jeonju-si, Republic of Korea
| | - Seok Hee Jeong
- College of Nursing, Research Institute of Nursing Science, Jeonbuk National University, Jeonju-si, Republic of Korea
| | - Myoung Hee Seo
- Department of Nursing Science, VISION College of Jeonju, Jeonju-si, Republic of Korea
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Distresse moral vivenciado por gestores enfermeiros no contexto de hospitais universitários federais. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao013534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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26
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Faraco MM, Gelbcke FL, Brehmer LCDF, Ramos FRS, Schneider DG, Silveira LR. Moral distress and moral resilience of nurse managers. Nurs Ethics 2022; 29:1253-1265. [PMID: 35549481 DOI: 10.1177/09697330221085770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Moral distress is a phenomenon that can lead to an imbalance of the mind and body. There are many coping strategies to overcome the obstacles that lead the subject to this condition. Some coping strategies are capable of being achieved through the cultivation of moral resilience. AIM The aim is to identify the strategies of moral resilience in the nursing management of University Hospitals in Brazil. RESEARCH DESIGN The research design is the qualitative study with discursive textual analysis. PARTICIPANTS AND RESEARCH CONTEXT : 44 nurse managers and nurses in leadership positions participated in a total of 30 University Hospitals in Brazil. Data were collected online, using a questionnaire with open questions. ETHICAL CONSIDERATIONS The Ethics Committee approved the study. Participants received information about the research, agreed to respond to the questionnaire, and were guaranteed anonymity. FINDINGS Personal adaptive strategies (intrapersonal and interpersonal) and organizational collaborative strategies (intrinsic and transformational management) emerged from this process. The intrapersonal strategies involved elements of rationality, flexibility, rebalancing practices, moral courage, and detachment. The interpersonal strategies addressed support networks, team involvement, and dialog. Organizational strategies dealt with actions which reorient ethical infrastructure, ethical education, and psychological protection, as well as fostering dialogical relationships, empowerment, and cooperation. CONCLUSION From the perspective of social historical construction, it is understood that developing personal and organizational strategies is essential to cultivating moral resilience.
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Dalmolin GDL, Lanes TC, Bernardi CMS, Ramos FRS. Conceptual framework for the ethical climate in health professionals. Nurs Ethics 2022; 29:1174-1185. [PMID: 35545250 DOI: 10.1177/09697330221075741] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The ethical climate is the perception of health professionals about the work environment, meaning the reflection on care practices and ethical-related decisions. There are extensive studies in the international literature about the ethical climate, but there are still theoretical gaps about it in health services. In this reflection article, the objective was to explore conceptual components about the ethical climate, proposing new elements of analysis of the construct. The starting point was the accumulated knowledge itself, the possibilities for expansion, and the conceptual progress emerging from contributions from studies on nursing ethics. It was understandable that the ethical climate is considered in its procedural model and cyclically, being articulated with organizational elements, as established in the literature, and, expanding the concept, with the worker's health and the ethical expressiveness at work. Regarding this last contribution, the suggestion is to think about the potential for work to allow, limit, or favor professionals to express their ethical and esthetic values in the most daily decisions and relationships, in care, management, and education. The conceptual framework of this study progressed by addressing the ethical climate as a process articulating several concepts and elements regarding the organizational aspect, ethics, and the workers' well-being.
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28
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Ventovaara P, Af Sandeberg M, Petersen G, Blomgren K, Pergert P. A cross-sectional survey of moral distress and ethical climate - Situations in paediatric oncology care that involve children's voices. Nurs Open 2022; 9:2108-2116. [PMID: 35441803 PMCID: PMC9190683 DOI: 10.1002/nop2.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/19/2022] [Accepted: 04/03/2022] [Indexed: 11/28/2022] Open
Abstract
Aim To assess experiences of morally distressing situations and perceptions of ethical climate in paediatric oncology care, with a focus on situations that involve children's voices. Design Cross‐sectional survey. Methods Registered Nurses at all four paediatric oncology centres in Denmark were asked to complete a web‐based questionnaire with Danish translations of the Swedish Moral Distress Scale‐Revised (MDS‐R) and the Swedish Hospital Ethical Climate Survey‐Shortened (HECS‐S). Data analysis included descriptive statistics and non‐parametric correlation tests. Results Nurses (n = 65) perceived morally distressing situations as rather uncommon, except for those that involved shortage of time, poor continuity of care and unsafe staffing levels. Most nurses (83%) found it disturbing to perform procedures on school‐aged children against their will, and 20% reported that they do this often. Perceptions of ethical climate were positive and healthcare professionals were perceived to be attentive to children's wishes.
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Affiliation(s)
- Päivi Ventovaara
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Paediatric Haematology and Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Af Sandeberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Paediatric Haematology and Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Gitte Petersen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Klas Blomgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Paediatric Haematology and Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Pergert
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Paediatric Haematology and Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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29
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Ozdoba P, Dziurka M, Pilewska-Kozak A, Dobrowolska B. Hospital Ethical Climate and Job Satisfaction among Nurses: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084554. [PMID: 35457422 PMCID: PMC9027856 DOI: 10.3390/ijerph19084554] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 12/10/2022]
Abstract
The aim of this study was to map and summarize the published research findings on hospital ethical climate and its relationship with nursing staff job satisfaction as well as strategies proposed in the literature for the improvement of hospital ethical climate and job satisfaction through the actions of nursing staff in leadership positions. A scoping review has been performed in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension scoping reviews statement (PRISMA-ScR). Three electronic bibliographic databases were searched: the SCOPUS, Medline, and CINHAL Complete using a combination of keywords with the range of years 1994–2021. A total of 15 papers out of 235 records identified were eligible for the analysis. The literature review confirmed a significant relationship between ethical climate and job satisfaction of nurses. Furthermore, the interdependence of ethical climate and job satisfaction of nursing staff affects many different aspects including patients, co-workers, an organization and research. Identifying factors that influence ethical climate and job satisfaction as well as the relationship between these variables may help to reduce the dropout concerning a change of profession among nursing staff.
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Affiliation(s)
- Patrycja Ozdoba
- Department of Holistic Care and Management in Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland; (M.D.); (B.D.)
- Correspondence:
| | - Magdalena Dziurka
- Department of Holistic Care and Management in Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland; (M.D.); (B.D.)
| | - Anna Pilewska-Kozak
- Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland;
| | - Beata Dobrowolska
- Department of Holistic Care and Management in Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland; (M.D.); (B.D.)
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Abstract
BACKGROUND Ethical sensitivity is a prerequisite for ethical nursing practices. Efforts to improve nurses' ethical sensitivity are required to correctly recognise ethical conflicts and for sound decision-making. Because an emerging infectious disease response involves complex ethical issues, it is important to understand the factors that influence public health nurses' ethical sensitivity while caring for patients with COVID-19, an emerging infectious disease. OBJECTIVES This study aims to identify the relationship between nursing professionalism, the organisation's ethical climate, and the ethical sensitivity of nurses who care for emerging infectious disease patients in Korean public health centres. Further, it sought to identify factors influencing ethical sensitivity and the mediating effect of the organisational ethical climate to inform guidelines and improve ethical sensitivity. RESEARCH DESIGN This was a cross-sectional descriptive study. PARTICIPANTS AND RESEARCH CONTEXT Data were collected from February 3 to 8 March 2021. Participants included 167 nurses caring for patients with COVID-19 in public health centres in South Korea. ETHICAL CONSIDERATION This study was approved by the Institutional Review Board of the Chung-Ang University and followed the principles of research ethics. RESULTS The factors influencing ethical sensitivity were working at a COVID-19 disease direct response department, nursing professionalism, and organisation's ethical climate. The organisation's ethical climate showed a partial mediating effect on the influence of nursing professionalism on ethical sensitivity. CONCLUSION Our findings show that nurses' ethical sensitivity can be improved by refining the organisation's ethical climate and nursing professionalism.
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Affiliation(s)
- Hyeji Seo
- Seoul Nurses Association, Seoul, Korea
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Abstract
BACKGROUND During disease outbreaks, nurses express concerns regarding the organizational and social support required to manage role conflicts. OBJECTIVES The study examined concerns, threats, and attitudes relating to care provision during the COVID-19 outbreak among nurses in Israel. DESIGN A 53-item questionnaire was designed for this research, including four open-ended questions. The article used a qualitative research to analyze the responses to the open-ended questions and their association with responses to the close-ended ones. PARTICIPANTS AND RESEARCH CONTEXT In all, 231 registered nurses and fourth-year nursing students throughout the whole country. The questionnaire was delivered in nursing Facebook and WhatsApp groups and through snowball sampling. ETHICAL CONSIDERATIONS The research was pre-approved by the Ethics Committee at the researchers' university. RESULTS Nurses mostly referred to personal risk, followed by dilemmas regarding care provision. On average, 38.6% of quotations stated that during the pandemic, nurses are not asked to perform unfair duties. Nurses discussed activities and requirements that impact their personal and familial safety, their relationship with employer, organization or the state, and their duty to providing care. Other than fear of contraction, respondents' most frequent themes of concerns were related to work condition and patients' interests, inter-collegiate relationships, and uncertainty and worries about the future. Respondents' ethical dilemmas mostly referred to clinical questions, providing care without adequate equipment or managerial support, and in conditions of uncertainty and increased risk. DISCUSSION Nurses raise important issues concerning their relationships with employers and family members, and significant insights regarding the pandemic and their revised responsibilities and definition of work. They raise serious concerns regarding their rights at work and their standing for them. CONCLUSIONS Health managers should find ways to enhance the ethical climate and institutional support to enable a better work-life balance in times of pandemic and support nurses' working needs and labor rights.
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Gagnon M, Payne A, Guta A. What are the ethical implications of using prize-based contingency management in substance use? A scoping review. Harm Reduct J 2021; 18:82. [PMID: 34348710 PMCID: PMC8335458 DOI: 10.1186/s12954-021-00529-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The area of substance use is notable for its early uptake of incentives and wealth of research on the topic. This is particularly true for prize-based contingency management (PB-CM), a particular type of incentive that uses a fishbowl prize-draw design. Given that PB-CM interventions are gaining momentum to address the dual public health crises of opiate and stimulant use in North America and beyond, it is imperative that we better understand and critically analyze their implications. PURPOSE The purpose of this scoping review paper is to identify the characteristics of PB-CM interventions for people who use substances and explore ethical implications documented in the literature as well as emerging ethical implications that merit further consideration. METHODS The PRISMA-ScR checklist was used in conjunction with Arksey and O'Malley's methodological framework to guide this scoping review. We completed a two-pronged analysis of 52 research articles retrieved through a comprehensive search across three key scholarly databases. After extracting descriptive data from each article, we used 9 key domains to identify characteristics of the interventions followed by an analysis of ethical implications. RESULTS We analyzed the characteristics of PB-CM interventions which were predominantly quantitative studies aimed at studying the efficacy of PB-CM interventions. All of the interventions used a prize-draw format with a classic magnitude of 50%. Most of the interventions combined both negative and positive direction to reward processes, behaviors, and/or outcomes. One ethical implication was identified in the literature: the risk of gambling relapse. We also found three emerging ethical implications by further analyzing participant characteristics, intervention designs, and potential impact on the patient-provider relationship. These implications include the potential deceptive nature of PB-CM, the emphasis placed on the individual behaviors to the detriment of social and structural determinants of health, and failures to address vulnerability and power dynamics. CONCLUSIONS This scoping review offers important insights into the ethics on PB-CM and its implications for research ethics, clinical ethics, and public health ethics. Additionally, it raises important questions that can inform future research and dialogues to further tease out the ethical issues associated with PB-CM.
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Affiliation(s)
- Marilou Gagnon
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada.
- School of Nursing, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
| | - Alayna Payne
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, ON, N9A 0C5, Canada
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Kneck Å, Mattsson E, Salzmann-Erikson M, Klarare A. "Stripped of dignity" - Women in homelessness and their perspectives of healthcare services: A qualitative study. Int J Nurs Stud 2021; 120:103974. [PMID: 34087526 DOI: 10.1016/j.ijnurstu.2021.103974] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND A much more substantial European evidence base on the accessibility of healthcare services among women experiencing homelessness across healthcare systems in Europe is warranted. OBJECTIVE To give voice to women with experiences of homelessness, and to explore their perspectives of healthcare services in an EU country with universal healthcare. DESIGN The study is part of a research program striving to promote equal healthcare through co-production with women in homelessness. An advisory board of women with lived experience of homelessness was established and a qualitative, interpretive and exploratory design was employed. PARTICIPANTS 26 women with experience of homelessness were interviewed. Their median age was 46 years (range 42) and 70% were roofless/houseless. METHODS Data were analyzed with content analysis. Co-production and joint analyses were conducted by researchers and three women with experience of homelessness, using the DEPICT model for collaborative analysis. RESULTS The analysis resulted in one overall theme: Visiting healthcare from the outskirts of society, comprising three sub-themes: Demand for a life in order - Exclusion in action; Unwell, unsafe and a woman - Multifaceted needs challenge healthcare; and Abuse versus humanity - power of healthcare encounters to raise or reduce. Women's experiences of care encounters were disparate, with prevalent control, mistrust and stigma, yet healthcare professionals that demonstrated respect for the woman's human dignity was described both as life-altering and lifesaving. CONCLUSIONS Women in homelessness live on the outskirts of society and have multiple experiences of exclusion and loss of dignity within healthcare services. The multifaceted care needs challenge healthcare, leading to women feeling alienated, invisible, disconnected and worthless. We urge registered nurses to take actions for inclusion health, i.e. focusing health efforts of people experiencing extreme health inequities. We can lead the way by speaking up and confronting discriminating behaviors, protecting and restoring human dignity in caring relationships, and framing healthcare services for all citizens. Tweetable abstract: Women in homelessness have multiple experiences of exclusion and loss of dignity within healthcare services. Nurses must frame healthcare to include all citizens.
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Affiliation(s)
- Åsa Kneck
- Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Stigbergsgatan 30, Box 111 89, 100 61, Stockholm, Sweden.
| | - Elisabet Mattsson
- Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Stigbergsgatan 30, Box 111 89, 100 61, Stockholm, Sweden; Uppsala University, Department of Women's and Children's Health, Clinical psychology in healthcare, 751 85, Uppsala, Sweden.
| | - Martin Salzmann-Erikson
- University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, 801 76, Gävle, Sweden.
| | - Anna Klarare
- Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Stigbergsgatan 30, Box 111 89, 100 61, Stockholm, Sweden; Uppsala University, Department of Women's and Children's Health, Clinical psychology in healthcare, 751 85, Uppsala, Sweden.
| | -
- Ersta Möjlighet, Stockholm, Sweden
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Rodríguez-Fernández M, Herrera J, de las Heras-Rosas C. Model of Organizational Commitment Applied to Health Management Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4496. [PMID: 33922667 PMCID: PMC8122969 DOI: 10.3390/ijerph18094496] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/15/2021] [Accepted: 04/22/2021] [Indexed: 12/17/2022]
Abstract
In this paper, we try to build on the problems surrounding the management of human resources in health care organizations worldwide. After the analysis of the reviewed literature, we detected that the scientific community considers several recurring themes that need attention: stress, burnout, and turnover intention. Based on this, we developed a model of organizational commitment that aims to achieve performance and health quality, its main result the establishment of the appropriate management policies in order to avoid the abandonment of the organization through the search for commitment and job satisfaction. Amongst our main conclusions, we highlight the need to implement a human resources model for hospital administrators based on the relationships with "patients" not "clients" through the maintenance of a positive and strong atmosphere of staff participation. It is important to develop innovative practices related to clear job design that eliminate reasons for ambiguity and stress in executing the tasks of the healthcare system. Finally, we urge training programs in transformational leadership to promote the well-being and organizational commitment of employees.
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Affiliation(s)
| | - Juan Herrera
- Department of Economics and Business Administration, Universidad de Málaga, 29071 Málaga, Spain
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Viđak M, Barać L, Tokalić R, Buljan I, Marušić A. Interventions for Organizational Climate and Culture in Academia: A Scoping Review. SCIENCE AND ENGINEERING ETHICS 2021; 27:24. [PMID: 33783667 DOI: 10.1007/s11948-021-00298-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/16/2021] [Indexed: 06/12/2023]
Abstract
Organizational climate and culture may influence different work-related outcomes, including responsible conduct of research and research misconduct in academic or research organizations. In this scoping review we collected evidence on outcomes of interventions to change organizational climate or culture in academic or research settings. Out of 32,093 documents retrieved by the search, we analysed 207 documents in full text, out of which 7 met the eligibility criteria and were included in the final analysis. The included studies measured organizational climate (2 studies), organizational culture (4 studies), or both (1 study) at biomedical faculties (4 studies) or non-academic university departments (3 studies). Four studies had post-test, and three before-and-after study designs. The majority of interventions were face-to-face activities (meetings, different teambuilding activities), and two were based on organizational change. Six studies reported positive changes in organizational climate/culture after the intervention. These positive changes were measured as improvements in score on different questionnaire survey or were described through authors' or external evaluator's narrative reports. However, the methodological quality of the studies was low, both for qualitative and quantitative study designs. Replicable studies, using rigorous methods and clearly defined outcomes are urgently needed if organizations want to achieve a real change in organizational climate or culture for responsible research. The protocol for this scoping review was registered at https://osf.io/7zjqb .
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Affiliation(s)
- Marin Viđak
- Department of Research in Biomedicine and Health, School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia.
| | - Lana Barać
- Department of Research in Biomedicine and Health, School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
| | - Ružica Tokalić
- Department of Research in Biomedicine and Health, School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
| | - Ivan Buljan
- Department of Research in Biomedicine and Health, School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
| | - Ana Marušić
- Department of Research in Biomedicine and Health, School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
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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: 19] [Impact Index Per Article: 6.3] [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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Abstract
BACKGROUND Positioned at the frontlines of the battle against COVID-19 disease, nurses are at increased risk of contraction, yet as they feel obligated to provide care, they also experience ethical pressure. RESEARCH QUESTION AND OBJECTIVES The study examined how Israeli nurses respond to ethical dilemmas and tension during the COVID-19 outbreak, and to what extent this is associated with their perceived risk and motivation to provide care? RESEARCH DESIGN The study implemented a descriptive correlative study using a 53-section online questionnaire, including 4 open-ended questions. PARTICIPANTS AND RESEARCH CONTEXT The questionnaire was complete by 231 registered and intern nurses after being posted on nurses' Facebook and WhatsApp groups, and through snowball sampling. ETHICAL CONSIDERATIONS The research was pre-approved by the ethics committee of the Faculty of Social Welfare and Health Sciences at the University of Haifa, Israel. FINDINGS In all, 68.8% of the respondents had received some form of training about COVID-19. Respondents positioned themselves at perceived high risk levels for contracting the virus. About one-third feared going to work because of potential contraction and due to feeling inadequately protected. While 40.9% were scared to care for COVID-19 patients, 74.7% did not believe they have the right to refuse to treat certain patients. When asked about defining an age limit for providing patients with scarce resources (such as ventilation machines) in cases of insufficient supplies, respondents stated that the maximum age in such scenarios should be 84 (standard deviation (SD = 19) - yet most respondents (81.4%) believed that every patient has the right to receive optimal treatment, regardless of their age and medical background. DISCUSSION Correlating with their strong commitment to care, nurses did not convey intention to leave the profession despite their stress, perceived risk, and feelings of insufficient support and protection at work. The nurses did not hold a utilitarian approach to resource allocation, thereby acknowledging the value of all people and their entitlement to care, regardless of optimal outcomes. CONCLUSION While experiencing significant personal risk and emotional burden, nurses conveyed strong dedication to providing care, and did not regret working in the nursing profession, yet they did seek a supportive climate for their needs and ethical concerns.
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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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Avancini RC, Barlem ELD, Tomaschewski-Barlem JG, Amorim CB, Rocha LP, Paloski GDR. Barreiras e facilitadores para construção de um ambiente ético em um serviço de traumatologia. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2021-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo identificar as principais barreiras e facilitadores do trabalho multiprofissional, com vistas à construção de um ambiente ético em um serviço de traumatologia. Método estudo exploratório-descritivo com abordagem qualitativa realizado com dez profissionais de uma equipe multiprofissional de uma unidade de traumatologia de um Hospital Universitário localizado no Sul do Brasil. Participaram três médicos, três médicos residentes, dois enfermeiros e dois técnicos em enfermagem. A coleta de dados ocorreu no período de setembro a outubro de 2019, por meio de Grupo Focal e foram submetidos à Análise Textual Discursiva. Resultados os dados permitiram a construção de duas categorias principais: as barreiras e os facilitadores encontrados para construção de um ambiente ético em um serviço de traumatologia. Conclusão e implicações para a prática como principais barreiras para a construção de um ambiente ético de trabalho foram identificadas a presença de diferentes vínculos empregatícios, a limitação de espaço físico e a burocracia e como facilitadores, foram destacados a presença de protocolos e comunicação efetiva que juntos podem resultar em uma direção para a construção de um ambiente ético de trabalho, de modo a ir ao encontro com a meta do serviço, no qual se constitui na humanização da assistência e a segurança do paciente.
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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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Abstract
BACKGROUND Nursing turnover is a very serious problem, and nursing managers need to be aware of how ethical climates are associated with turnover intention. OBJECTIVES The article explored the effects of ethical climates on nurses' turnover intention, mediated through trust in their organization. METHODS A cross-sectional survey of 285 nurses from three Indian hospitals was conducted to test the research model. Various established Likert-type scales were used to measure ethical climates, turnover intention and trust in organization. Hierarchical regression analysis and mediation analysis were used to test the model. RESULTS Hierarchical regression analysis and mediation analysis were used to test the model. The indirect effect of benevolent ethical climate on turnover intention through trust in organization was -0.20 with a 95% bootstrap confidence interval of lower level = -0.31 and upper level = -0.01. The indirect effect of principled ethical climate on turnover intention through trust in organization was -0.39 with a 95% bootstrap confidence interval of lower level = -0.58 and upper level = -0.17. ETHICAL CONSIDERATIONS The study adheres to the ethical standards recommended by the American Psychological Association for conducting research with informed consent, confidentiality and privacy. CONCLUSION Both benevolent and principled ethical climates decreased turnover intention indirectly through trust in organization. Only principled ethical climates were directly associated with turnover intention. Our results suggest that nurse managers and leaders should try and establish principled and benevolent climates in order to engender trust in organization and to reduce turnover intention.
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Affiliation(s)
| | - Jatin Pandey
- 29691Indian Institute of Management Indore, India
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[Moral distress in medical students and young professionals: research desiderata in the context of the COVID-19 pandemic]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:1483-1490. [PMID: 33180160 PMCID: PMC7659897 DOI: 10.1007/s00103-020-03244-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/09/2020] [Indexed: 11/29/2022]
Abstract
Hintergrund Die COVID-19-Pandemie stellt Menschen, die in der medizinischen Versorgung arbeiten, vor besondere Herausforderungen. Ein Teil der Medizinstudierenden und ärztlichen Berufseinsteigenden, die in dieser Zeit in Einrichtungen der Gesundheitsversorgung ihre Mitarbeit beginnen, wird mit außergewöhnlichen moralischen Herausforderungen konfrontiert. Einige verfügen noch nicht über ausreichend Bewältigungsmöglichkeiten, um adäquat mit diesen Herausforderungen umzugehen. Dies kann zu sogenanntem moralischen Stress (MoS; Englisch: „moral distress“, MoD) führen. Dauerhafte oder intensive Belastung durch MoS kann gravierende Folgen haben. Geeignete Unterstützungsangebote haben das Potenzial, den Umgang mit MoS zu verbessern. Ziel Der Beitrag hat das Ziel, einen Überblick über den Stand der Forschung zu MoS von Medizinstudierenden und ärztlichen Berufseinsteigenden zu geben, um Lehrende mit Aus- und Weiterbildungsverantwortung und Ärzt*innen in Leitungspositionen für die Problematik zu sensibilisieren. Hauptteil In diesem Beitrag werden das wissenschaftliche Konzept MoS, bekannte Auslöser sowie Präventions- und Interventionsmöglichkeiten vorgestellt. Dazu wird das Thema Bezug nehmend auf die Veränderungen in der Patientenversorgung im Kontext der COVID-19-Pandemie analysiert und es werden Forschungsdesiderate aufgezeigt. Fazit Der Beitrag verdeutlicht die Notwendigkeit eines deutschsprachigen, interdisziplinären Diskurses über MoS bei Medizinstudierenden und Berufseinsteigenden.
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Hognestad Haaland G, Olsen E, Mikkelsen A. The association between supervisor support and ethical dilemmas on Nurses' intention to leave: The mediating role of the meaning of work. J Nurs Manag 2020; 29:286-293. [PMID: 32893914 DOI: 10.1111/jonm.13153] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 12/18/2022]
Abstract
AIM To examine the association between supervisor support and ethical dilemmas on nurses' intention to leave health care organisations, both directly and through the mediating role of the meaning of work. BACKGROUND The shortage of nurses makes it vital that organisations retain nurses and so reduce the costs associated with replacing experienced nurses. METHODS This cross-sectional study samples 2,946 registered nurses from a selected health region in Norway. Structural equation modelling was used to test a hypothesized model. RESULTS Social support from the supervisor and ethical dilemmas is associated with nurses' intention to leave, both directly and indirectly through the mediating role of the meaning of work. CONCLUSION Health care organisations should enhance social support from supervisors and the meaning of work, and reduce the level of ethical dilemmas in hospitals. IMPLICATIONS FOR NURSING MANAGEMENT Health care organisations should continuously develop and offer training in nurse manager skills, such as being empathic, understanding employees' needs and how to communicate and handle ethical dilemmas. Managers should value staff contributions, encourage staff involvement in ethical questions and highlight the impact of nurses' work on improving the welfare of others.
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Affiliation(s)
- Guro Hognestad Haaland
- Stavanger University Hospital, Stavanger, Norway.,Business School, University of Stavanger, Stavanger, Norway
| | - Espen Olsen
- Business School, University of Stavanger, Stavanger, Norway
| | - Aslaug Mikkelsen
- Stavanger University Hospital, Stavanger, Norway.,Business School, University of Stavanger, Stavanger, Norway
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Maffoni M, Sommovigo V, Giardini A, Paolucci S, Setti I. Dealing with ethical issues in rehabilitation medicine: The relationship between managerial support and emotional exhaustion is mediated by moral distress and enhanced by positive affectivity and resilience. J Nurs Manag 2020; 28:1114-1125. [PMID: 32495373 DOI: 10.1111/jonm.13059] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
AIMS To analyse whether managerial support and ethical vision of patient care would be related to emotional exhaustion directly or through moral distress and whether these relationships would be conditional on individual levels of positive affectivity and resilience. BACKGROUND Although some studies described the effects of ethical climate, moral distress, resilience and positive affectivity on emotional exhaustion, there are no attempts of explicative models containing these variables. METHODS A total of 222 Italian professionals employed in neuro-rehabilitation medicine units participated in this cross-sectional study. Descriptive statistics, mediation and moderated mediation analyses were conducted using SPSS. RESULTS Managerial support and ethical vision of patient care were negatively related to emotional exhaustion, directly and through moral distress. Professionals high in resilience and positive affectivity benefited more from the protective effect of managerial support on emotional exhaustion through moral distress. CONCLUSION Ethical climate represents a protective factor against moral distress and emotional exhaustion. Moreover, individual levels of positive affectivity and resilience may increase the beneficial effects deriving from managerial support in dealing with ethical issues. IMPLICATION FOR NURSING MANAGEMENT Health organisations may consider developing strategies to improve ethical climate, enhance managers' ability to support team in dealing with ethical issues and foster employees' positive affectivity and resilience.
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Affiliation(s)
- Marina Maffoni
- Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia, Pavia, Italy.,Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Valentina Sommovigo
- Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia, Pavia, Italy
| | - Anna Giardini
- Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Ilaria Setti
- Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia, Pavia, Italy
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Ethical Conflicts Experienced by Nurses in Geriatric Hospitals in South Korea: "If You Can't Stand the Heat, Get Out of the Kitchen". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124442. [PMID: 32575765 PMCID: PMC7345032 DOI: 10.3390/ijerph17124442] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022]
Abstract
Ethical conflicts among nurses can undermine nurses’ psychological comfort and compromise the quality of patient care. In the last decade, several empirical studies on the phenomena related to ethical conflicts, such as ethical dilemmas, issues, problems, difficulties, or challenges, have been reported; however, they have not always deeply explored the meaning of ethical conflicts experienced by nurses in geriatric care. This study aims to understand the lived experiences of ethical conflict of nurses in geriatric hospitals in South Korea. A phenomenological study was conducted. In-depth, face-to-face interviews were performed with nine registered nurses who cared for elderly patients in geriatric hospitals in South Korea between August 2015 and January 2016. Three main themes emerged from the analysis: (1) confusing values for good nursing, (2) distress resulting from not taking required action despite knowing about a problem, and (3) avoiding ethical conflicts as a last resort. It was found that for geriatric nurses to cope with ethical conflicts successfully, clear ethical guidance, continuing ethics education to improve ethical knowledge and moral behaviors, and a supportive system or program to resolve ethical conflicts involving nurses should be established.
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Tehranineshat B, Torabizadeh C, Bijani M. A study of the relationship between professional values and ethical climate and nurses' professional quality of life in Iran. Int J Nurs Sci 2020; 7:313-319. [PMID: 32817854 PMCID: PMC7424154 DOI: 10.1016/j.ijnss.2020.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/17/2020] [Accepted: 06/04/2020] [Indexed: 11/16/2022] Open
Abstract
Objective To explore the relationship between nursing professional values and ethical climate and nurses’ professional quality of life. Methods The present study is a descriptive, cross-sectional work in which 400 nurses from various wards of hospitals in the south-east of Iran were studied. Data were collected using a questionnaire consisting of four sections: demographics, Nurses’ Professional Values Scale-Revised (NPVS-R), the Hospital Ethical Climate Survey (HECS), and the Professional Quality of Life Scale (ProQOL). Results The total mean scores for professional values were 105.29 ± 15.60. The total mean score for the ethical climate was 100.09 ± 17.11. The mean scores for the indexes of compassion satisfaction, burnout, and secondary traumatic stress were 45.29 ± 8.93, 34.38 ± 6.84, and 32.15 ± 7.02 respectively. The relationships between professional values and the indexes of compassion satisfaction (r = 0.56), burnout (r = 0.26), and secondary traumatic stress (r = 0.18) were found to be positive and significant (P < 0.001). Also, the relationships between ethical climate and the items of compassion satisfaction (r = 0.60, P < 0.001), burnout (r = 0.15, P = 0.002) were found to be positive and significant. Conclusion An understanding of nurses’ perception of professional values and improving the ethical climate at work can help nursing administrators identify more effective strategies toward increasing compassion satisfaction and lessening burnout and work-related stress.
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Affiliation(s)
- Banafsheh Tehranineshat
- Department of Nursing and Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Camellia Torabizadeh
- Department of Nursing and Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Bijani
- Department of Medical Surgical Nursing, Fasa University of Medical Sciences, Fasa, Iran
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Chan HY. Remapping the organ donation ethical climate: a care ethics consideration. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:295-308. [PMID: 31811525 DOI: 10.1007/s11019-019-09934-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Organ donation has gained much attention as the need for transplant exceeds the supply of organs. Various proposals have been put forward to address the organ shortage challenge, ranging from offering incentives to donors, addressing family refusals to donations and instituting presumed consent laws. Presumed consent as the favoured approach has not been universally effective in increasing actual transplants despite its appeal. Few considerations have been given to the broader ethical climate influencing the organ donation debate. This paper examines the ethical climate surrounding organ donation and identifies the challenges existing within such environments. It explores care ethics and its application to the donation system, demonstrating how it can influence the organ donation phases. The conclusion drawn from the analysis is that a caring ethical climate in the pre, during and post-transplant system respects donor autonomy, addresses family reluctance to agree to donation, facilitates the needs of the donee and creates an environment that promotes non-maleficence for all stakeholders.
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Alonso Castillo MM, Armendaríz Garcia NA, Alonso Castillo MTDJ, Alonso Castillo BA, López García KS. Clima ético, estrés de conciencia y laboral de enfermeras y médicos que laboran en cuidados intensivos neonatal. REVISTA LATINOAMERICANA DE BIOÉTICA 2020. [DOI: 10.18359/rlbi.4177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
El objetivo del presente estudio fue determinar la relación entre la percepción del clima ético, el estrés moral y el relacionado con el trabajo. El diseño fue descriptivo correlacional y el muestreo fue tipo censo con un total de muestra de 106 participantes (80 profesionales de enfermería y 26 médicos). Los resultados mostraron que existe una relación negativa y significativa del clima ético con el estrés laboral (rs =-.326, p<.01). Además, se identificó como hallazgo adicional que el clima ético predice el estrés relacionado con el trabajo, tanto en médicos como en enfermeras (R2=7.9, p=.004). La evidencia científica del presente estudio confirma que la bioética como ciencia debe ser competencia de todos los profesionales de la salud y, en particular, de la enfermería, debido a los desafíos éticos y morales de su práctica profesional, especialmente en áreas críticas debido a las políticas, la normatividad y los recursos con los que cuentan el lugar de trabajo. Tanto el clima ético como el estrés moral y laboral deben ser considerados por las instituciones de salud, teniendo en cuenta que pueden influir negativamente en la salud de los médicos y enfermeras que brindan los cuidados, lo cual limita la calidad de la atención.
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Silén M, Svantesson M. Impact of clinical ethics support on daily practice-First-line managers' experiences in the Euro-MCD project. J Nurs Manag 2019; 27:1374-1383. [PMID: 31220384 DOI: 10.1111/jonm.12818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 05/21/2019] [Accepted: 06/14/2019] [Indexed: 11/29/2022]
Abstract
AIM To explore first-line managers' experiences of what Moral Case Deliberation has meant for daily practice, to describe perceptions of context influence and responsibility to manage ethically difficult situations. BACKGROUND In order to find measures to evaluate Moral Case Deliberation, the European Moral Case Deliberation Outcome instrument was developed and is now in the stage of revision. For this, there is a need of several perspectives, one of them being the managerial bird-eye perspective. METHOD Eleven first-line managers at workplaces, participating in the European Moral Case Deliberation Outcome instrument project, were interviewed and thematic analysis was applied. RESULTS Managers' experiences were interpreted as enhanced ethical climate: a closer-knit and more emotionally mature team, morally strengthened individuals, as well as ethics leaving its marks on everyday work and morally grounded actions. Despite organizational barriers, they felt inspired to continue ethics work. CONCLUSION AND IMPLICATIONS This study confirmed, but also added ethical climate aspects, such as morally grounded actions. Furthermore, adding ethical climate as a construct in the European Moral Case Deliberation Outcome instrument should be considered. First-line managers need clear directives from their managers that ethics work needs to be prioritized for the good of both the staff and the patients.
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Affiliation(s)
- Marit Silén
- Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Mia Svantesson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
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'You can give them wings to fly': a qualitative study on values-based leadership in health care. BMC Med Ethics 2019; 20:35. [PMID: 31133017 PMCID: PMC6537214 DOI: 10.1186/s12910-019-0374-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 05/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Within contemporary health care, many of the decisions affecting the health and well-being of patients are not being made by the clinicians or health professionals, but by those involved in health care management. Existing literature on organizational ethics provides insight into the various structures, processes and strategies - such as mission statement, ethics committees, ethical rounds … - that exist to create an organizational climate, which fosters ethical practices and decision-making It does not, however, show how health care managers experience their job as being intrinsically ethical in itself. In the present article, we investigate the way in which ethical values are present in the lived experiences and daily practice of health care management. What does it imply to take up a managing position within a health care institution and to try to do this in an ethically inspired way? METHOD We carried out a qualitative study (Grounded Theory Approach) to explore the essence of values-based leadership in health care. We interviewed 15 people with extensive experience in health care management in the fields of elderly care, hospital care and mental health care in the various regions of Flanders, Belgium. RESULTS Six predominant themes, presented as metaphors, illustrate the essence of values-based leadership in health care management. These are: (1) values-based health care management as managing a large garden, (2) as learning and using a foreign language, (3) going on a trekking with an ethical compass, (4) embodying integrity and authenticity in a credible encounter with everyone, (5) being a present and trustworthy leader during sun and storm, and (6) contributing to human flourishing by giving people wings to fly. CONCLUSIONS Notwithstanding the importance of organizing a good ethics infrastructure, values-based leadership in health care entails much more than that. It is about the co-creation of an integrated and comprehensive ethical climate of which community-model thinking and authentic leadership are essential components. As a never-ending process, the six metaphors can help leaders to take substantive proactive steps to shape a fruitful ethical climate within their organization.
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