Effects of ethical leadership on nurses' service behaviors

Managerial ethical principles and behaviours for nurse managers: A Delphi method

BACKGROUND

Managerial ethical principles and behaviours guide the roles, duties, responsibilities, behaviours, and relationships of nurse managers in healthcare institutions.

RESEARCH OBJECTIVES

The aim of this study was to establish the managerial ethical principles and behaviours for nurse managers.

RESEARCH QUESTION

What are the managerial ethical principles and behaviours for nurse managers?

RESEARCH DESIGN

The Delphi method, one of the qualitative research methods, was used in this study. The Delphi process consisted of two rounds. Data were collected by e-Delphi technique.

PARTICIPATIONS

42 experts were included in the first Delphi round and 39 in the second Delphi round. These experts consisted of nurse managers, academicians studying in the field of ethics and nursing management.

ETHICAL CONSIDERATIONS

Participation in the study was voluntary and informed consent of the experts was obtained before the study. Approval was obtained from the ethics committee of the university at which the researcher worked (Approval date: 24.07.2020, Decision No: 2020/12-16).

FINDINGS

At the end of the Delphi rounds, eight managerial ethical principles and 29 ethical behaviours of these principles were identified. The distribution of these behaviours and principles were: justice (six behaviours), equality (two behaviours), honesty (two behaviours), fairness (two behaviours), responsibility (eight behaviours), confidentiality (two behaviours), clarity (two behaviours), and humanity (five behaviours).

CONCLUSION

These managerial ethical principles and behaviours are intended to guide nurse managers when providing nursing services but should be updated accordingly in line with changing conditions and developments.

Challenge or Hindrance? The Dual Impact of Algorithmic Control on Gig Workers' Prosocial Service Behaviors

Algorithmic technological progress presents both opportunities and challenges for organizational management. The success of online labor platforms hinges on algorithmic control, making it imperative to explore how this control affects gig workers' prosocial service behaviors. Drawing from affective event theory, our study delves into the factors influencing gig workers' prosocial service behaviors in the online labor platform setting. We utilize the challenge-hindrance appraisal framework to highlight the pivotal role of algorithmic control. To rigorously test our hypotheses, we gathered empirical data from an online questionnaire survey of 660 gig workers. Our results indicate that challenge appraisals and hindrance appraisals in regard to platform algorithm control have a nuanced dual impact on gig workers' prosocial service behaviors. This relationship is clarified by the mediating function of work engagement. A challenge appraisal of platform algorithmic control can positively influence gig workers' prosocial service behaviors. However, hindrance appraisal of platform algorithmic control can negatively influence gig workers' prosocial service behaviors. Interestingly, workplace interpersonal capitalization boosts the effect of challenge appraisal on employees' prosocial service behaviors. However, it does not mitigate the adverse effects of hindrance appraisal on such behaviors. This study has multiple theoretical implications, and it also provides valuable practical insights into organizational management.

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

BACKGROUND

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

PURPOSE

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

PARTICIPANTS AND RESEARCH CONTEXT

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

RESEARCH DESIGN

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

ETHICAL CONSIDERATIONS

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

RESULTS AND DISCUSSION

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

CONCLUSION

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

A latent profile analysis of psychological resilience associated with work fatigue among Chinese nurses

Nurses' psychological resilience has been studied using a variable-centered rather than a person-centered approach, impeding a comprehensive understanding of the holistic expression of these different forms of psychological resilience. This study aimed to examine the characteristics of psychological resilience in a sample of Chinese nurses during COVID-19 using latent profile analysis (LPA) and the relationships between these unique profiles and nurses' work fatigue. A total of 471 Chinese nurses were recruited from three hospitals in Hebei Province between June and July 2020. The participant samples were investigated with the psychological resilience scale and the work fatigue inventory. LPA showed that a three-profile model of psychological resilience best fit this study. The resulting profiles were low psychological resilience, medium psychological resilience, and high psychological resilience. Notably, there were significant differences in nurses' work fatigue among different profiles of psychological resilience. The study provided a new view of nurses' psychological resilience, which may be used to effectively reduce nurses' work fatigue and evaluate nursing work status comprehensively.

Barriers to ethical treatment of patients in clinical environments: A systematic narrative review

Background and Aim

It is essential that healthcare providers display ethical behavior toward their patients. Despite development of codes of ethics for clinical practice, the occurrence of unethical behaviors toward patients is alarmingly high. The present study was conducted to identify the barriers to ethical treatment of patients in clinical environments.

Methods

Through systematic narrative review, the present study investigated the barriers to ethical treatment of patients. This study was carried out in line with Assessment of Multiple Systematic Reviews 2 and Preferred Reporting Items of Systematic reviews and Meta-Analyses guidelines.

Results

Ethical challenges in clinical environments can be classified into two categories: "organizational factors" and "personal factors." Organizational factors consist of three domains: managers and regulations, organizational environment, and human resources. Personal factors consist of two domains: factors related to patients and their families and factors related to care providers.

Conclusion

Research shows that encouraging healthcare teams to adopt ethical behaviors through education and having them persistently observe ethics in their clinical practice will not completely bridge the gap between theory and practice: it seems that the clinical environment, the personal characteristics of healthcare team members and patients, and the organizational values of the healthcare system pose the greatest barrier to bridging this gap. Accordingly, in addition to raising healthcare providers' awareness of the existing issues in clinical ethics, measures should be taken to improve organizational culture and atmosphere.

Ethical climate, moral resilience, and ethical competence of head nurses

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.

Impacts of ethical climate and ethical sensitivity on caring efficacy

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.

Ethical Leadership in LTC: From Caregivers' Customer Orientation to Senior's Satisfaction and Well-Being

Background

In response to the growth of the world's senior population, an investigation of ethical leadership on LTCs is needed, in particular in the impact it may have on customer orientation and on seniors' well-being.

Objective

We propose a model to identify the relationship between ethical leadership in LTCs and caregivers' customer orientation, and its influence on satisfaction with the service, satisfaction with life, and the quality of the interaction between caregivers and seniors.

Sampling

We present a matched sample of 277 caregivers and 277 elderly Brazilians, workers and seniors' in LTCs in Brazil. The minimum sample size was 222, determined using G-Power software version 3.1.9.2, based on the desired statistical power parameters and the number of predictors. Two structured questionnaires were developed, one for caregivers and the other for the elderly. 69 LTCs were contacted and 29 participated in the survey (10 nonprofit, 34.48%). Data were treated statistically using SEM modelling.

Results

We identified a positive influence of ethical leadership on caregivers' attitudes, favoring their orientation towards the seniors'. A positive relationship between customer-oriented caregivers and customer satisfaction, life satisfaction, and the quality of the senior's interaction. A customer-oriented caregiver exerts a mediating effect between ethical leadership and the seniors' related outcomes, making ethical leadership beneficial to seniors and their family members.

Conclusion

Ethical leadership favors successful management of LTCs, increasing customer orientation, and provides clues to establish a better causality and a chain of effects between leadership and senior-related outcomes. Therefore, LTCs may be the appropriate outlet for the role of ethics in leadership.

Practical Implications

This study provides managers with an understanding of the effects of ethical leadership in the context of LTCs, for both caregivers and seniors. The powerful effects of ethical leadership can be a stimulus to increase the role of ethics in LTCs, improving the quality of care, the well-being of the seniors, and, therefore, the human and financial performance of these institutions.

The associations between benevolent leadership, affective commitment, work engagement and helping behavior of nurses: a cross-sectional study

BACKGROUND

Benevolent leadership is common in organizations, including hospitals, and is known to have positive effects on employees. Yet, nursing literature lacks sufficient research on its relationships with nurses' behavior.

METHODS

In March to April 2022, a cross-sectional study was carried out involving 320 nurses employed across various hospitals in Sichuan Province, China. Benevolent leadership, affective commitment, work engagement, and helping behavior were evaluated using the Benevolent Leadership Scale, Affective Commitment Scale, Work Engagement Scale, and Helping Behavior Questionnaire, respectively. The study employed structural equation model and the bootstrap method to investigate the proposed relationships.

RESULTS

The SEM analysis results indicated a positive association between benevolent leadership and several outcomes among nurses. Specifically, benevolent leadership was found to be positively associated with nurses' affective commitment (β = 0.58, p < .001), work engagement (β = 0.02, p < .001), and helping behavior (β = 0.17, p = .001). Additionally, there was a significant indirect effect between benevolent leadership and nurses' work engagement through affective commitment (β = 0.08, p = .007) as well as between benevolent leadership and helping behavior through affective commitment (β = 0.16, p < .001).

CONCLUSIONS

This study's findings emphasize the crucial role of benevolent leadership in fostering nurses' positive attitudes and behaviors in the workplace. Hospital administrators could promote the benevolent leadership of head nurses to enhance nurses' affective commitment, work engagement, and helping behaviors.

Latent profiles of ethical climate and nurses' service behavior

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.

Strategies and challenges in addressing ethical issues in the hospital context: A phenomenological study of nurse team leaders

Background

Nurse team leaders encounter considerable ethical challenges that necessitate using effective strategies to overcome them. However, there is a lack of research exploring the experiences of nurse team leaders in Indonesia who face ethical dilemmas in their professional duties.

Objective

This study aimed to explore nurse team leaders' experiences regarding strategies and challenges in dealing with ethical problems in hospital settings in Indonesia.

Methods

This qualitative study employed a hermeneutic phenomenology design. Online semi-structured interviews were conducted between November 2021 and February 2022 among 14 nurse team leaders selected using a snowball sampling from seven hospitals (three public and four private hospitals). Van Manen's approach was used for data analysis.

Results

The strategies for overcoming ethical dilemmas included (i) seeking the facts, (ii) stepping back, (iii) considering support, and (iv) standing by patients. The challenges for the nurse team leaders in resolving ethical problems consisted of (i) seniority, (ii) trust issue, and (iii) lack of reflection and ethics training.

Conclusion

Nurse team leaders recognize their specific roles in the midst of ethical challenges and seek strategies to deal with them. However, a negative working environment might impact ethical behavior and compromise the provision of quality care. Therefore, it is imperative for hospital management to take note of these findings and address issues related to seniority by providing regular ethics training and group reflection sessions to maintain nurses' ethical knowledge in hospital practice. Such interventions can support nurse team leaders in resolving ethical dilemmas and provide a conducive environment for ethical decision-making, ultimately improving patient outcomes.

Nurses' assessment of the ethical climate of a university hospital in the South of Brazil

Background

Ethical climate can be defined as the healthcare professionals' perceptions of the ethical treatment of healthcare issues and human interactions in their work environment. A number of studies on ethical climate are being carried out in several countries. In Brazil, however, research on the matter is still incipient, especially among hospital nurses.

Aim

To assess nurses' perception of the ethical climate in a university hospital in the South of Brazil.

Methods

Cross-sectional study carried out with 269 nurses from a university hospital, using a sociodemographic and occupational profiling survey and the Hospital Ethical Climate Survey - Brazilian version. Data analysis was done through descriptive statistics.

Results

The nurses' perception of the ethical climate was positive (3.68 ± 0.55). Among the five assessment factors, 'peers' had the highest score (4.07 ± 0.57), whereas 'physicians' had the lowest score (3.26 ± 0.70) for ethical climate.

Conclusion

In general, the ethical climate was perceived as positive, with small variations between the factors of the instrument. Ethical climate could be enhanced through strategies that encourage interpersonal relationships. This study shows the importance of a positive ethical climate based on good relationships between healthcare professionals for ensuring better care.

Factors influencing public health nurses' ethical sensitivity during the pandemic

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.

Conceptual framework for the ethical climate in health professionals

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.

Development and psychometric evaluation of the nurse behavior toward confirmed and suspected HIV/AIDS patients (NB-CSHAP) scale

There is a scarcity of literature discussing nurses’ behaviors toward caring for suspected or confirmed human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients. The development of a scale specific to measure nurses’ behaviors will allow health institutions to assess the disposition of their nurses in terms of HIV care. This study aims to present the rigors of developing and validating a reliable instrument to contextualize these nurses’ behaviors. This study utilized a sequential exploratory mixed method design to develop the NB-CSHAP scale. Thematic analysis was done on the qualitative data from the interviews with persons living with HIV/AIDS (PLHA) from which items were selected to be included in the scale. Exploratory factor analysis was utilized to extract the factors and Cronbach's alpha was used to assess the reliability of the instrument. Four factors were extracted and are categorized as either caring or discriminatory behaviors. These include: (1) service-oriented, (2) openhanded, (3) perceptive, and (4) discriminatory. The scale has an internal consistency of 0.73. The scale shows acceptable psychometric properties, hence can be used to assess the nurses’ behaviors in caring for confirmed or suspected HIV clients. The scale may be used by health institutions to determine the quality of the patient care provided by their nurses to clients with confirmed or suspected HIV.

Missed nursing care and its relationship with perceived ethical leadership

BACKGROUND

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

AIM

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

RESEARCH DESIGN

A cross-sectional study.

PARTICIPANTS AND RESEARCH CONTEXT

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

ETHICAL CONSIDERATIONS

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

FINDINGS

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

DISCUSSION

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

CONCLUSION

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

The relationship between ethical climate and nursing service behavior in public and private hospitals: a cross-sectional study in China

Background

Workplace climate is a great significant element that has an impact on nurses’ behavior and practice; moreover, nurses’ service behavior contributes to the patients’ satisfaction and subsequently to the long-term success of hospitals. Few studies explore how different types of organizational ethical climate encourage nurses to engage in both in-role and extra-role service behaviors, especially in comparing the influencing process between public and private hospitals. This study aimed to compare the relationship between the five types of ethical climate and nurses’ in-role and extra-role service behaviors in public and private hospitals.

Methods

This study conducted a cross-sectional survey on 559 nurses from China in May 2019. The questionnaire was distributed to nurses by sending a web link via the mobile phone application WeChat through snowball sampling methods. All participants were investigated using the Ethical Climate Scale and Service Behavior Questionnaire. SPSS 22.0 was used for correlation analysis, t-test, and analysis of variance test, and Mplus 7.4 was used for group comparison (p < .05).

Results

The law and code climate has a much greater influence on nurses’ in-role service behavior in private hospitals than on that in public hospitals (β = − 0.277; CI _95 % = [-0.452, − 0.075]; p < .01), and the instrumental climate has a stronger influence on nurses’ extra-role service behavior private hospitals than on that in public hospitals (β = − 0.352; CI _95 % = [-0.651, − 0.056]; p < .05). Meanwhile, the rules climate has a greater effect on nurses’ extra-role service behavior in public hospitals than it does in private hospitals (β = 0.397; CI 95 % = [0.120, 0.651]; p < .01).

Conclusions

As the relationship between the five types of ethical climate and nurses’ in-role and extra-role service behaviors in public and private hospitals were different, the strategies used to foster and enhance the types of ethical climate are various from public to private hospitals. The caring and instrumental climate are the key to promote extra-role service behavior for nurses in private hospitals. And the independent climate has a great effect on extra-role service behaviors for nurses in public hospitals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00655-7.

Effect of Ethical Leadership on Moral Sensitivity in Chinese Nurses: A Multilevel Structural Equation Model

To explore the relationship between ethical leadership (a contextual factor at the higher organizational level) and nurses' moral sensitivity (the individual outcome at a lower level), a cross-sectional quantitative study design was used. Participants were 525 nurses at 65 various departments in public tertiary hospitals. These results showed that ethical climate played a mediating role in the relationship between ethical leadership and nurses' moral sensitivity. Moreover, nurses' employment type moderated the mediating effect of ethical leadership on their moral sensitivity. Additionally, the link between ethical climate and moral sensitivity of contract nurses was stronger than that of nurses employed by the state.

Factors related to implementation of nursing care ethical principles in Indonesia

Background: The implementation of ethical principles is crucial in carrying out nursing care, since it is part of the 12 basic competencies, that should be possessed by a nurse. This study aims to analyse the factors associated with the implementation of nurses’ ethical principles.

Design and Methods: This study used a quantitative research design, with a cross-sectional approach. The participants consisted of 389 nurses, working in the medical ward of the hospitals, in Indonesia. Data were analysed using the bivariate analysis, t-test, ANOVA and multiple linear regression test.

Results: There were no significant relationships between the demographic factors and the ethical behaviour. There was a relationship between caring behaviour and the application of ethical principles (p=0.000, and a correlation coefficient of 0.602).

Conclusion: Nurse ethical behaviour was improved, by increasing their caring attitude.

Ethical Dilemma: An Unprecedented Strike by Health care Workers in Early February 2020 in Hong Kong

Urging the government to exercise a complete border closure to inhibit the spread of the novel coronavirus from Mainland China, about 8,000 health care workers participated in a 5-day strike in early February 2020 in Hong Kong. Despite gaining 61% support from the public, dissenters criticised that the participants violated professional ethics and abandoned their accountabilities, which led to moral distress. However, the participants were guided by the four fundamental medical principles (autonomy, beneficence, non-maleficence, and justice) for public interest and health equity. Their concerns for occupational safety should not be ignored to maintain an effective health care system. In short, the strike adopted a bottom-up initiative and adhered to a public-centered perspective and community-driven ethical behaviors, through which the participants deliberated over professionalism, humanism and the imminence of public health, and the balance between them. Strikers showed care and concern for the safety of the community, sustainability of the health care system, and well-being of all people in Hong Kong.

A latent profile analysis of nurses' moral sensitivity

BACKGROUND

The three-dimensional model of nurses' moral sensitivity has typically been studied using a variable-centered rather than a person-centered approach, preventing a more complete understanding of how these forms of moral sensitivity are expressed as a whole. Latent profile analysis is a person-centered approach that classifies individuals from a heterogeneous population into homogeneous subgroups, helping identify how different subpopulations of nurses use distinct combinations of different moral sensitivities to affect their service behaviors.

OBJECTIVE

Latent profile analysis was used to identify three distinct profiles of nurses' moral sensitivity. Associations of the profiles with service behaviors were then examined.

METHODS

Five hundred twenty-five nurses from three tertiary hospitals in China were investigated with Moral Sensitivity Questionnaire and Nurses' Service Behavior Scale. Latent profile analysis was used to analyze the data.

ETHICAL CONSIDERATIONS

Approval was obtained from the Ethics committee for biomedical research of Medical College, the Hebei University of Engineering.

RESULTS

A three-profile moral sensitivity model provided the best fit to the data. The resulting profiles were low moral sensitivity, moderate moral sensitivity, and high moral sensitivity. There were significant differences in service behaviors among different profiles of moral sensitivity.

CONCLUSION

The results provide a new and expanded view of nurses' moral sensitivity, which may be used to monitor nurses' service behaviors comprehensively and to evaluate nursing ethics management strategies.

High-Power Distance Is Not Always Bad: Ethical Leadership Results in Feedback Seeking

Feedback seeking relates positively to organizational identification and task performance. However, an individual generally views seeking feedback as risky. It remains unclear whether, why, and when ethical leadership impacts on feedback-seeking behavior. This research aimed to explore the mediating role of psychological safety in the relationship between ethical leadership and nurses’ feedback seeking and to further explore the moderating effect of power distance in this mechanism. After eliminating invalid surveys, the sample included 458 pairs. The SPSS PROCESS macro was used for the data analysis. The results indicate that ethical leadership positively affected nurses’ feedback-seeking. Ethical leadership influences feedback seeking through psychological safety. With high power distance, ethical leadership significantly positively influenced psychological safety and then positively affected feedback-seeking behavior. In sum, in the context of high-power distance, ethical leadership is especially important for psychological safety and feedback-seeking behavior.