The association between perceived hospital ethical climate and self-evaluated care quality for COVID-19 patients: the mediating role of ethical sensitivity among Chinese anti-pandemic nurses

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.

Clinical internship environment and caring behaviours among nursing students: A moderated mediation model

BACKGROUND

Caring behaviour is critical for nursing quality, and the clinical internship environment is a crucial setting for preparing nursing students for caring behaviours. Evidence about how to develop nursing students' caring behaviour in the clinical environment is still emerging. However, the mechanism between the clinical internship environment and caring behaviour remains unclear, especially the mediating role of moral sensitivity and the moderating effect of self-efficacy.

RESEARCH OBJECTIVE

This study aimed to examine the mediating effect of moral sensitivity and the moderating function of self-efficacy on the association between the clinical internship environment and caring behaviours.

RESEARCH DESIGN

A cross-sectional design used acceptable validity scales. The hypothesised moderated mediation model was tested in the SPSS PROCESS macro.

PARTICIPANTS AND RESEARCH CONTEXT

This survey collected data from 504 nursing students in an internship at a teaching hospital in Changsha, China.

ETHICAL CONSIDERATIONS

This study was pre-approved by the ethics committee of the medical school (No. E2022210). Informed consent was obtained from all students.

RESULTS

The clinical internship environment (B = 0.450, 95% CI = [0.371, 0.530]) and moral sensitivity (B = 1.352, 95% CI = [1.090, 1.615]) had positive direct effects on nursing students' caring behaviours. Clinical internship environment also indirectly influenced students' caring behaviours via moral sensitivity (B = 0.161, 95% CI = [0.115, 0.206]). In addition, self-efficacy played a moderating role between the clinical internship environment and caring behaviours (B = 0.019, 95% CI = [0.007, 0.031]), as well as the relationship between the clinical internship environment and moral sensitivity (B = 0.006, 95% CI = [0.003, 0.010]).

CONCLUSION

Moral sensitivity mediates the effect of the clinical internship environment on caring behaviour, and self-efficacy strengthens both direct and indirect effects. This study emphasises the importance of self-efficacy in developing moral sensitivity and caring behaviours in nursing students.

Analysis of influencing factors of orthopedic nurses' spiritual care competencies based on structural equation model

Purpose

To comprehensively understand the spiritual care competencies of orthopedic nurses and analyze the factors that affect them.

Methods

This study employed convenience sampling to conduct a cross-sectional survey among orthopedic nurses at Hefei First People's Hospital. Data was collected utilizing a general information questionnaire, alongside the Chinese versions of the Spiritual Care Competence Scale, the Spiritual Care Perspective Scale, the Professional Identity Assessment Scale, and the Hospital Ethical Climate Scale. Guided by the Person-Environment Fit theory and the Triadic Reciprocal Determinism theory, a structural equation model was utilized to analyze the influencing factors and pathways related to the spiritual care competence of orthopedic nurses.

Results

A total of 112 valid questionnaires were obtained, yielding an overall score of 68.92 ± 11.03 for orthopedic nurses' spiritual care competencies, with an average score of 3.14 ± 0.50 per item. The results of the Pearson correlation analysis revealed a significant positive correlation (all P < 0.01) between spiritual care competence and the scores for spiritual care perspective, professional identity assessment, and hospital ethical climate. The spiritual care perspective, professional identity, and hospital ethical climate emerged as the influencing factors of orthopedic nurses' spiritual care competence, exhibiting total effects of 0.30, 0.53, and 0.85, respectively. Notably, the hospital ethical climate exerts an indirect influence on spiritual care competence through the mediation of spiritual care perspective and professional identity, with the indirect effect accounting for 61.18% of the total effect.

Conclusion

There remains significant potential for enhancing the spiritual care competencies of orthopedic nurses. The hospital's ethical climate not only has a direct and positive impact on spiritual care competence but also indirectly influences it through the lens of nurses' spiritual care perspectives and professional identity assessments. Hospital administrators may wish to consider strategies for bolstering the hospital's ethical climate, fostering a deeper spiritual care perspective and heightened professional identity among nurses, and ultimately improving their spiritual care competence.

Ethical Climate in the Delivery Wards of Educational Hospitals in Southeast Iran

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.

Effects of ethical climate in association with tenure on work addiction, quality of care and staff retention: a cross-sectional study

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.

Reflections of nurses in the fight against COVID-19 in Hubei: a qualitative study

OBJECTIVES

To explore the reflections and experiences of nurses who were deployed to the frontline to combat COVID-19 in Wuhan, China. In order to gain insights that can be useful in developing cultivating positive professional values and attitudes towards future public health emergencies.

DESIGN

Qualitative study using semistructured interviews. Data were transcribed and analysed using the Colaizzi's 7-step method. The study is reported in accordance with the consolidated Standards for Reporting Qualitative Research.

SETTING

Telephonic interviews with nine participants who were deployed from Nanjing to Hubei Province for the fight against COVID-19.

PARTICIPANTS

Of 11 volunteer nurses deployed to Hubei Province for the fight against COVID-19, two nurses did not finish the interview because of their working hours. The remaining nine were recruited through purposive sampling using the following criteria: nurses who were deployed at the first stage and those who verbally agreed and signed an informed consent form to participate in the study.

RESULTS

Three thematic categories and subthemes that were identified from the analysis were as follows: (1) 'Assertive attitude to fight against the pandemic', included three subthemes: 'Inner calling towards professional accountability for saving lives', 'Extrinsic support that facilitates the commitment to the nursing profession' and 'Holistic value ascribed to the nursing profession'. (2) 'Challenges associated with the anti-pandemic mission', included 'overcoming challenges around the strict requirements for personal protection' and 'Fear and uncertainty over the rapid progression of the disease'. (3) 'Unbearable heaviness and lightness of being a nurse', with two subthemes: 'the heavy crown of the anti-pandemic hero' and 'eternal reverence without regrets'.

CONCLUSIONS

As reflected by the nurses on frontline combating COVID-19, it was necessary to inculcate professional nursing values in them, as only their dedication and selflessness could improve humanity's chances against the disease.

Compassion fatigue and moral sensitivity in midwives in COVID-19

BACKGROUND

The Covid-19 pandemic has impacted compassion fatigue and the mental health of health care providers, particularly midwives and nurses. Although there are studies involving health workers such as nurses and physicians affected by the pandemic's compassion fatigue, few studies include midwives.

RESEARCH OBJECTIVE

The present study seeks to investigate the effects of compassion fatigue experienced by midwives working under intense stress during the third wave of the COVID-19 pandemic on the level of moral sensitivity.

RESEARCH DESIGN

This is a descriptive-correlation study.

PARTICIPANTS

The statistical population consisted of all the midwives in Türkiye hospitals in 2021. This cross-sectional study was collected through a questionnaire using convenience sampling. Three hundred and ten midwives working in different units of the country participated in the study.

ETHICAL CONSIDERATIONS

Approval from the researcher's university Institutional Review Board for ethical review was obtained with the code of IRB 20/510.

FINDINGS

The average age of the midwives is 34.29 ± 8.39. It has been noticed that 43.5% of the midwives work in public hospitals and 38.1% in family health and community health centers. Midwives' mean MR-CS score is 67.11 ± 25.13, secondary trauma sub-dimension average 15.77 ± 6.23, and occupational burnout sub-dimension 40.69 ± 16.35. The mean moral sensitivity questionnaire score is determined as 93.86 ± 19.51. It has been observed that the working style and working time are effective on compassion fatigue. In the linear regression model, 98% of compassion fatigue was explained. Age, secondary trauma, and occupational burnout sub-dimensions affect the model.

DISCUSSION

Working year, working style, second trauma, age, and occupational burnout parameters may help explain some of the links between midwives' symptoms of compassion fatigue.

CONCLUSION

The pandemic affects the compassion fatigue of midwives. It is crucial to provide social support to midwives and health workers to prevent compassion fatigue and examine and control groups at risk in mental health.

Trends and ethical issues in nursing during disasters: A systematic review

BACKGROUND

During a disaster, nurses face complex ethical challenges because of risky situations. It is necessary to identify trends and ethical issues of nurses in disasters to improve the quality of care and impact for nurses.

METHOD

This systematic review enrolled in the international registration with PROSPERO: CRD42022350765. We searched the following databases: PubMed, EBSCO MEDLINE, SCOPUS, ProQuest, ScienceDirect, and Sage Pub. The inclusion criteria were developed according to PICO and D; are Population (F): involving nurses; intervention/Exposure (I): disaster, Comparison (C): none; outcome (O): ethical practice. And Design (D): qualitative, quantitative, and mixed methods. Years of publication were 2012-2022, with full text in English. The quality of study assessment used was The Joanna Briggs Institute (JBI) Critical Appraisal tool and Mixed Methods Appraisal Tool (MMAT) version 2018. Analysis used PICO synthesis.

RESULTS

There were 15 studies reviewed from 2093 results, including cross-sectional (4/15, 26.6%), qualitative (9/15, 60%), and mixed methods (2/15, 13.3%) studies. The types of disasters were: COVID-19 (7/15, 46.6%), infectious (4/15, 26.6%), and all disaster events (4/15, 26.6%). The main themes were: (1) ethical issues in disasters have the potential to address ethical dilemmas, (2) factors applying nursing ethics to support ethical decision-making in disasters, (3) strategies for applying ethics and dealing with ethical issues in disasters, and (4) the impact of applying ethics in disasters.

CONCLUSION

Applying ethics nursing in a disaster is influenced by various factors. This framework for ethical nursing in disasters aims to help nurses, educational institutions, and policymakers develop schemes or scenarios to enhance responsible ethical decisions in disasters.

Ethical climate in healthcare: A systematic review and meta-analysis

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.

Hospital ethical climate survey - selected psychometric properties of the scale and results among polish nurses and midwives

BACKGROUND

The hospital ethical climate affects the quality of nursing care. A positive ethical climate is likely to reduce the proportion of those who consider leaving the profession, so it is necessary to develop tools which will enable assessment and analysis of the hospital ethical climate. The aim of this study was to examine selected psychometric properties of the Polish version of the Hospital Ethical Climate Survey, assess the hospital ethical climate perceived by nurses and midwives from Polish hospitals, and to determine its correlations with job-related variables.

METHODS

A cross-sectional study among 558 nurses and midwives working in hospitals in Poland.

RESULTS

The 21-item model showed acceptable model fitness between the hypothetical model of ethical climate and the data in the study. Five items with low factor loadings were removed from the study. The internal consistency was satisfactory (0.93). The mean score for the overall hospital ethical climate was 3.62. The highest mean score of hospital ethical climate in the present study was found in the "peers" subscale and the lowest in the "physicians" subscale. A positive correlation was found between overall hospital ethical climate and respondents' satisfaction with work, salary, and working time. The hospital ethical climate was associated with problems found in nurses and midwives' work, such as: limited time for direct face-to-face care, the lack of equipment and resources to provide high-quality health care, strained relations with hospital managers and other health care professionals, limitations to one's own competences or those of other medical professionals, moral dilemmas related to patient care, the low prestige of nurses'/midwives' work, physical and mental burden, and the risk of making a mistake.

CONCLUSION

The Polish 21-item version of the Hospital Ethical Climate Survey is a reliable tool. Correlations revealed that relationships with managers and physicians, and working conditions should be improved in order for the hospital ethical climate to improve.

Crisis, ethical leadership and moral courage: Ethical climate during COVID-19

Background

The global COVID-19 pandemic has challenged nurse leaders in ways that one could not imagine. Along with ongoing priorities of providing high quality, cost-effective and safe care, nurse leaders are also committed to promote an ethical climate that support nurses’ moral courage for sustaining excellence in patient and family care.

Aim

This study is directed to develop a structure equation model of crisis, ethical leadership and nurses’ moral courage: mediating effect of ethical climate during COVID-19.

Ethical consideration

Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University, Egypt.

Methods

A cross-sectional design was used to conduct this study using validated scales to measure the study variables. It was conducted in all units of two isolated hospitals in Damanhur, Egypt. A convenient sample of 235 nurses was recruited to be involved in this study.

Results

This study revealed that nurses perceived a moderate mean percent (55.49 ± 3.46) of overall crisis leadership, high mean percent (74.69 ± 6.15) of overall ethical leadership, high mean percent (72.09 ± 7.73) of their moral courage, and moderate mean percent of overall ethical climate (65.67 ± 12.04). Additionally, this study declared a strong positive statistical significant correlation between all study variables and indicated that the independent variable (crisis and ethical leadership) can predict a 0.96, 0.6, respectively, increasing in the dependent variable (nurses’ moral courage) through the mediating impact of ethical climate.

Conclusion

Nursing administrators should be conscious of the importance of crisis, ethical leadership competencies and the role of ethical climate to enhance nurses’ moral courage especially during pandemic. Therefore, these findings have significant contributions that support healthcare organizations to develop strategies that provide a supportive ethical climate. Develop ethical and crisis leadership competencies in order to improve nurses' moral courage by holding meetings, workshops, and allowing open dialogue with nurses to assess their moral courage.