Is Gender an Antecedent to Workplace Stressors? A Systematic Review and an Empirical Study Using a Person-Centred Approach.

OBJECTIVE: Work is a key domain of life in which gender inequality can manifest, yet gender is rarely the explicit focus of research seeking to understand exposure to stressors. We investigated this research gap in two studies. METHODS: Study 1 was a systematic review of the relationship between gender and key stressors (e.g., high demands, poor support, lack of clarity and control). From a total of 13,376,130 papers met our inclusion criteria. Study 2 was a cross-sectional study that included 11,289 employees nested within 71 public organisations (50.6% men). Through a latent profile analysis, we investigated the profiles of stressors separately from men and women. RESULTS: The systematic review revealed that, for all stressors, a significant proportion of studies found no significant gender differences, and the review found mixed evidence of greater exposure for both men and women. The results of Study 2 revealed that both genders could be optimally represented by three psychosocial risk profiles reflecting medium, low and high stressors. The results also showed that while the shape of profiles was similar for both genders, men had a higher probability than women of being in the virtuous (i.e., low stressors) profile, and the opposite pattern emerged for the average profile (i.e., medium levels of stressors). Men and women displayed the same likelihood of being classified in the at-risk profile (i.e., high levels of stressors). CONCLUSION: Gender differences in exposure to stressors are inconsistent. Although the literature on gender role theory and the gendering of work suggests different exposures to stressors in men and women, we find little empirical support for this.

The protective role of work self-efficacy on wellbeing during COVID-19 pandemic: Results from a longitudinal year-long study.

In this study, we focused on four work self-efficacy dimensions and their relationship with wellbeing during the COVID-19 pandemic. We adopted a person-centered approach and investigated whether individuals with different work self-efficacy profiles would have different wellbeing experiences at 6 and 12 months from the beginning of the pandemic. Data were collected in the UK across three waves (January 2020, October 2020 and January 2021) on a sample of 393 full-time employees. Results showed that being in two at-risk profiles significantly increases the likelihood of experiencing lower wellbeing during the pandemic. In particular, the probability of belonging to the Profile 3 "low self-efficacy but high empathic" significantly increased the risk of lower wellbeing in the shorter and longer timeframe. In addition, the probability of belonging to the Profile 2 "high assertive and task self-efficacy but low emotional" also significantly increased the risk of lower wellbeing in the longer timeframe.

Do Multicomponent Workplace Health and Wellbeing Programs Predict Changes in Health and Wellbeing?

Organizations typically deploy multiple health and wellbeing practices in an overall program. We explore whether practices in workplace health and wellbeing programs cohere around a small number of archetypal categories or whether differences between organizations are better explained by a continuum. We also examine whether adopting multiple practices predicts subsequent changes in health and wellbeing. Using survey data from 146 organizations, we found differences between organizations were best characterized by a continuum ranging from less to more extensive adoption of practices. Using two-wave multilevel survey data at both individual and organizational levels (N = 6968 individuals, N = 58 organizations), we found that, in organizations that adopt a wider range of health and wellbeing practices, workers with poor baseline psychological wellbeing were more likely to report subsequent improvements in wellbeing and workers who reported good physical health at baseline were less likely to report experiencing poor health at follow-up. We found no evidence that adopting multiple health and wellbeing practices buffered the impact of individuals' workplace psychosocial hazards on physical health or psychological wellbeing.

Mental health, well-being and support interventions for UK ambulance services staff: an evidence map, 2000 to 2020.

BACKGROUND: Prior to COVID-19 there had been a renewed policy focus in the National Health Service on the health and well-being of the healthcare workforce, with the ambulance sector identified as a priority area. This focus is more important than ever as the sector deals with the acute and longer-term consequences of a pandemic. AIM: To systematically identify, summarise and map the evidence regarding mental health, well-being and support interventions for United Kingdom ambulance services staff and to identify evidence gaps. METHOD: Evidence mapping methodology of published and grey original research published in English from 1 January 2000 to 23 May 2020 describing the health risk, mental health and/or well-being of UK ambulance services staff including retired staff, volunteers and students. MEDLINE, EMBASE, PsychINFO, CINAHL and AMED databases, plus EThOS, Zetoc, OpenGrey and Google, were searched, alongside hand-searching of grey literature and bibliographies. Information was extracted on study aims, sample, design and methodology, funding source, country and key findings. Included studies were categorised into seven a priori theme areas. RESULTS: Of 1862 identified articles, 45 peer-reviewed studies are included as well as 24 grey literature documents. Peer-reviewed research was largely observational and focused on prevalence studies, post-traumatic stress disorder or organisational and individual social factors related to health and well-being. Most grey literature reported the development and testing of interventions. Across all study types, underpinning theory was often not cited. CONCLUSION: To date, intervention research has largely been funded by charities and published in the grey literature. Few studies were identified on self-harm, bullying, sleep and fatigue or alcohol and substance use. Theoretically informed intervention development and testing, including adaptation of innovations from other countries and 24-hour workforces, is needed. This evidence map provides important context for planning of staff well-being provision and research as the sector responds to and recovers from the pandemic. PROSPERO REGISTRATION NUMBER: CRD42018104659.

Caregivers' engagement during in-hospital care of sABI's patients: Evaluation of informal co-production from the health providers' perspective.

One of the challenges of providing healthcare services is to enhance its value (for patients, staff and the service) by integrating the informal caregivers into the care process, both concretely managing their patient's health conditions and treatment (co-executing) and participating in the whole healthcare process (co-planning). This study aims at exploring the co-production contribution to the healthcare process, analysing whether and how it is related to higher caregivers' satisfaction with service care and reduced staff burnout, in the eyes of the staff. It also investigated two possible factors supporting caregivers in their role of co-producers, namely relationship among staff and informal caregivers related to knowledge sharing (i.e. an ability determinant supporting co-production) and related to role social conflict (i.e. a willingness determinant reducing co-production). Results of a structural equation model on a sample of 119 healthcare providers employed by neurorehabilitation centers in Italy with severe acquired brain injury confirmed that knowledge sharing positively related with caregivers' co-executing and co-planning. Also, social role conflict was negatively related with co-executing but positively with co-planning. Furthermore, co-planning resulted in being unrelated to both outcomes, whereas co-executing was associated with caregivers' satisfaction, as measured by staff perceptions. Overall, our data provided initial empirical evidence supporting the ability of the determinant's contribution in allowing informal caregivers to assume an active role in both co-production domains. Furthermore, as expected, the role of conflict willingness determinant was found to be a hindering factor for co-executing but, conversely, a trigger for co-planning. This result should be considered more carefully in future studies.

Assessing the Risk of Stress in Organizations: Getting the Measure of Organizational-Level Stressors.

Great Britain's Health and Safety Executive (HSE) developed the Management Standards Indicator Tool to help organizations to assess and monitor organizational risks of work-related stress through surveying employees about the psychosocial risks for stress in their jobs. The use of employee-level data for deriving an organizational-level measure of psychosocial risks assumes that the constructs have equivalent meanings at different levels. However, this isomorphic condition has never been tested and this study fills this gap. Using data collected by the Italian Workers' Compensation Authority (INAIL) from 66,188 employees nested in 775 organizations, we demonstrate that the organizational-level measure representing the seven dimensions of the Management Standards Indicator Tool is equivalent, though not identical, to the individual-level measure. This implies that the organizational level is not a mirror of the aggregation of the individual level, and that the risk of work-related stress in an organization may derive not simply from bottom-up processes, but may be generated by top-down influences (e.g., organizational policies). Interventions may then be meaningfully targeted at the organizational level in the expectation that they will reduce the risk of work-related stress among the entire workforce, the valid measurement of which can be performed through the HSE's Management Standards Indicator Tool.

Assessing Objective and Verifiable Indicators Associated With Work-Related Stress: Validation of a Structured Checklist for the Assessment and Management of Work-Related Stress.

Risk assessment represents an essential part of any successful intervention in health and safety at work. The most prominent European methodologies propose multi-method approaches for identifying the risks associated with work-related stress. Nevertheless, the most widely used method is the self-administered questionnaire. By adapting the UK Management Standards approach, the Italian National Workers Compensation Authority (INAIL) developed a checklist for the assessment of objective and verifiable indicators of work-related stress. This checklist is filled in by a steering group composed of homogenous groups of workers. Through a web-platform developed by INAIL, a considerable amount of data over the last 5 years has been collected throughout Italy. The aims of this study are to examine the psychometric properties as well as the practical validity of the checklist in a wide sample of Italian companies. The sample comprised 5,301 homogeneous groups of workers nested within 1,631 organizations. The checklist measures two main areas: (1) the organizational indicators of work-related stress (sentinel events) and (2) four and six factors related respectively to content and context of work. Multilevel and multivariate analyses revealed that the checklist shows adequate factor structure and criterion validity. Results also demonstrate that small companies and the public and healthcare sector show higher risk levels. These results support the use of the checklist as a structured and generalizable tool for assessing and monitoring the risks associated with work-related stress.

The Role of Professional Competency in Influencing Job Satisfaction and Organizational Citizenship Behavior Among Palliative Care Nurses.

It is crucial that palliative care nurses feel competent to practice their profession in accordance with ethical principles, to personalize care, to remain sensitive, to ensure respect, and to communicate effectively. The aim of this study was to verify that higher levels of perceived professional competency predict better individual and organizational outcomes, such as job satisfaction and organizational citizenship behavior. An online cross-sectional survey was conducted with 107 Italian palliative care nurses. Structural equation modeling technique was used for data analysis. The model fitted the data well. Professional competency was positively associated with both job satisfaction (ß = 0.39) and organizational citizenship behavior (ß = 0.53). The more confidence palliative care nurses have in their professional competency, the more they are satisfied with their job and engage in organizational citizenship behavior. Fostering professional competency in palliative nursing can help not only patients and their families but also the nurses themselves, the organization, and their coworkers.

'First, Do No Harm': The Role of Negative Emotions and Moral Disengagement in Understanding the Relationship Between Workplace Aggression and Misbehavior.

Workplace aggression is a critical phenomenon particularly in the healthcare sector, where nurses are especially at risk of bullying and third-party aggression. While workplace aggression has been frequently examined in relation to health problems, less is known about the possible negative impact such aggression may have on the (un)ethical behavior of victims. Our research aims to fill this gap. Drawing on literature on counterproductive work behavior (CWB) and the social-cognitive literature on aggression we investigated in two independent studies (NStudy1 = 439; NStudy2 = 416), the role of negative emotions - in particular anger, fear, and sadness, - and of moral disengagement (MD) in the paths between workplace aggression, CWB and health symptoms. The focus on these relationships is rooted in two reasons. First, misbehavior at work is a pervasive phenomenon worldwide and second, little research has been conducted in the healthcare sector on this type of behavior despite the potential importance of the issue in this context. We empirically tested our hypotheses considering a specific form of workplace aggression in each study: workplace bullying or third-party aggression. Results from the two empirical studies confirm the hypotheses that being target of workplace aggression (bullying or third-party aggression) is not only associated with health symptoms but also with misbehavior. In addition, the results of structural equation modeling attest the importance of examining specific discrete negative emotions and MD for better understanding misbehavior at work. In particular, this research shows for the first time that anger, fear, and sadness, generally aggregated into a single dimension, are indeed differently associated with MD, misbehavior and health symptoms. Specifically, in line with the literature on discrete emotions, while sadness is only associated with health symptoms, anger and fear are related to both health and misbehavior.

Machiavellian Ways to Academic Cheating: A Mediational and Interactional Model.

Academic cheating has become a pervasive practice from primary schools to university. This study aims at investigating this phenomenon through a nomological network which integrates different theoretical frameworks and models, such as trait and social-cognitive theories and models regarding the approaches to learning and contextual/normative environment. Results on a sample of more than 200 Italian university students show that the Amoral Manipulation facet of Machiavellianism, Academic Moral Disengagement, Deep Approach to Learning, and Normative Academic Cheating are significantly associated with Individual Academic Cheating. Moreover, results show a significant latent interaction effect between Normative Academic Cheating and Amoral Manipulation Machiavellianism: "amoral Machiavellians" students are more prone to resort to Academic Cheating in contexts where Academic Cheating is adopted as a practice by their peers, while this effect is not significant in contexts where Academic Cheating is not normative. Results also show that Academic Moral Disengagement and Deep Approach to learning partially mediate the relationship between Amoral Manipulation and Academic Cheating. Practical implications of these results are discussed.

Neonatal intensive care parent satisfaction: a multicenter study translating and validating the Italian EMPATHIC-N questionnaire.

BACKGROUND: In Neonatal Intensive Care Units (NICUs), parent satisfaction and their experiences are fundamental to assess clinical practice and improve the quality of care delivered to infants and parents. Recently, a specific instrument, the EMpowerment of PArents in THe Intensive Care-Neonatology (EMPATHIC-N), has been developed in the Netherlands. This instrument investigated different domains of care in NICUs from a family-centered care perspective. In Italy, no rigorous instruments are available to evaluate parent satisfaction and experiences in NICU with family-centered care. The aim of this study was to translate and validate the EMPATHIC-N instrument into Italian language measuring parent satisfaction. METHODS: A psychometric study was conducted in nine Italian NICUs. The hospitals were allocated across Italy: four in the North, four in Central region, one in the South. Parents whose infants were discharged from the Units were enrolled. Parents whose infants died were excluded. RESULTS: Back-forward translation was conducted. Twelve parents reviewed the instrument to assess the cultural adaptation; none of the items fell below the cut-off of 80% agreement. A total of 186 parents of infants who were discharged from nine NICUs were invited to participate and 162 parents responded and returned the questionnaire (87%). The mean scores of the individual items varied between 4.3 and 5.9. Confirmatory factor analysis was performed and all factor loadings were statistically significant with the exception of item 'Our cultural background was taken into account'. The items related to overall satisfaction showed a higher trend with mean values of 5.8 and 5.9. The Cronbach's alpha's (at domain level 0.73-0.92) and corrected item-total scale correlations revealed high reliability estimates. CONCLUSIONS: The Italian EMPATHIC-N showed to be a valid and reliable instrument measuring parent satisfaction in NICUs from a family-centered care perspective. Indeed, it had good psychometric properties, validity, and reliability. Furthermore, this instrument is fundamental for further research and internationally benchmarking.

The protective role of self-efficacy against workplace incivility and burnout in nursing: A time-lagged study.

BACKGROUND: Incivility has negative consequences in the workplace and remains a prevalent issue in nursing. Research has consistently linked incivility to nurse burnout and, in turn, to poor mental health and turnover intentions. To retain high-quality nurses, it is important to understand what factors might protect nurses from the negative effects of workplace mistreatment. PURPOSE: The aim of the study was to investigate the role of relational occupational coping self-efficacy in protecting nurses from workplace incivility and related burnout and turnover intentions. METHODOLOGY: A two-wave national sample of 596 Canadian nurses completed mail surveys both at Time 1 and one year later at Time 2. Structural equation modeling was used to test the hypothesized model. RESULTS: The model showed a good fit, and most of the hypothesized paths were significant. Overall, the results supported the hypothesized protective effect of relational occupational coping self-efficacy against incivility and later burnout, mental health, and turnover intentions. CONCLUSION: Relational occupational coping self-efficacy is an important protective factor against negative work behavior. PRACTICE IMPLICATIONS: Organizations should provide nurses with opportunities to build their coping strategies for managing job demands and difficult interpersonal interactions. Similarly, providing exposure to effective role models and providing meaningful verbal encouragement are other sources of efficacy information for building nurses' relational coping self-efficacy.

Psychometric Characteristics of a New Scale for Measuring Self-efficacy in the Regulation of Gambling Behavior.

Since its introduction in 1977, self-efficacy has proven to be a fundamental predictor of positive adjustment and achievement in many domains. In problem gambling studies, self-efficacy has been defined mainly as an individual's ability to avoid gambling in risky situations. The interest in this construct developed mainly with regard to treatment approaches, where abstinence from gambling is required. Very little is known, however, regarding self-efficacy as a protective factor for problem gambling. This study aims to fill this gap, proposing a new self-efficacy scale which measures not only the ability to restrain oneself from gambling but also the ability to self-regulate one's gambling behavior. Two studies were conducted in which the data from two Italian prevalence surveys on problem gambling were considered. A total of about 6,000 participants were involved. In the first study, the psychometric characteristics of this new self-efficacy scale were investigated through exploratory and confirmatory factor analyses. The results indicated the presence of two different factors: self-efficacy in self-regulating gambling behavior and self-efficacy in avoiding risky gambling behavior. The second study confirmed the replicability of the two-factor solution and displayed high correlations among these two self-efficacy dimensions and different measures of gambling activities as well as other psychological variables related to gambling (gambling beliefs, gambling motivation, risk propensity, and impulsiveness). The results of logistic regression analyses showed the particular importance of self-regulating gaming behavior in explaining problem gambling as measured by Problem Gambling Severity Index and South Oaks Gambling Screen, thus proving the role of self-efficacy as a pivotal protective factor for problem gambling.

[The ethical leadership of the nursing ward managers as a key determinant of nurses' organisational behaviours in the healthcare settings]. / La leadership etica del coordinatore come fattore determinante i comportamenti organizzativi degli infermieri, nei luoghi di cura.

AIM: The main aim of this study is to examine the influence of the coordinator's ethical leadership on nurses' emotions (i.e., positive and negative) and work behaviours. METHOD: A questionnaire was administered in paper format, including well-validated scales reported in literature, to a sample of 347 nurses working in a university hospital. A structural equation model has been tested after examining Pearson's correlations among study variables. RESULTS: The coordinator's ethical leadership is strongly related to the implementation of nurses' organisational citizenship behaviour and counterproductive work behaviour, which are influenced by their emotions. Positive emotions fully mediate the relationship between ethical leadership and organisational citizenship behaviour, while negative emotions partially mediate the relationship between ethical leadership and counterproductive work behaviour. CONCLUSIONS: Ethical leadership acts on nurses' organisational behaviour, as described in the modelling process. The nurses' organisational behaviour is crucial to the outcome of the health care service. Therefore, the ethical leadership indirectly affects the quality of the care and the cure offered to the patients.

Violating organizational and social norms in the workplace: a correlational study in the nursing context. / Violare le norme organizzative e sociali nei luoghi di lavoro: studio correlazionale nel contest infermieristico.

OBJECTIVES: The aim of this study was to examine, in a sample of nurses, the relationships between the organizational context variables (i.e., workload, interpersonal conflicts, organizational constraints), the burnout, the moral disengagement, and the counterproductive work behaviors (CWB), within their clinical work settings. METHODS: A descriptive, correlational study was conducted in a sample of 347 nurses working in different clinical settings in a big university hospital in Central Italy. A self-report questionnaire was used for data collection, using several scales to assess different variables related to the organisational context, the burnout, the interpersonal strain, the moral disengagement, and the CWB. RESULTS: The clinical context was found to influence nurses' organizational wellbeing, which in turn was found to foster CWB. Nurses working in outpatients settings and in day hospitals were those who reported the lowest CWB, in comparison with nurses working in the Emergency Department and in the General Medicine Units. CONCLUSIONS: Findings of this study are important for nursing professional chiefs and for any professional involved in the promotion of workers' wellbeing. Our study findings highlight how the clinical work setting and the organizational context variables can lead to CWB. Researchers and managers should keep these aspects in high consideration due to their influence on the quality of the care delivered.

Patterns of Self-care in Adults With Heart Failure and Their Associations With Sociodemographic and Clinical Characteristics, Quality of Life, and Hospitalizations: A Cluster Analysis.

BACKGROUND: Self-care is important in heart failure (HF) treatment, but patients may have difficulties and be inconsistent in its performance. Inconsistencies in self-care behaviors may mirror patterns of self-care in HF patients that are worth identifying to provide interventions tailored to patients. OBJECTIVES: The aims of this study are to identify clusters of HF patients in relation to self-care behaviors and to examine and compare the profile of each HF patient cluster considering the patient's sociodemographics, clinical variables, quality of life, and hospitalizations. METHODS: This was a secondary analysis of data from a cross-sectional study in which we enrolled 1192 HF patients across Italy. A cluster analysis was used to identify clusters of patients based on the European Heart Failure Self-care Behaviour Scale factor scores. Analysis of variance and χ test were used to examine the characteristics of each cluster. RESULTS: Patients were 72.4 years old on average, and 58% were men. Four clusters of patients were identified: (1) high consistent adherence with high consulting behaviors, characterized by younger patients, with higher formal education and higher income, less clinically compromised, with the best physical and mental quality of life (QOL) and lowest hospitalization rates; (2) low consistent adherence with low consulting behaviors, characterized mainly by male patients, with lower formal education and lowest income, more clinically compromised, and worse mental QOL; (3) inconsistent adherence with low consulting behaviors, characterized by patients who were less likely to have a caregiver, with the longest illness duration, the highest number of prescribed medications, and the best mental QOL; (4) and inconsistent adherence with high consulting behaviors, characterized by patients who were mostly female, with lower formal education, worst cognitive impairment, worst physical and mental QOL, and higher hospitalization rates. CONCLUSION: The 4 clusters identified in this study and their associated characteristics could be used to tailor interventions aimed at improving self-care behaviors in HF patients.

Academic dishonesty among Italian nursing students: A longitudinal study.

Considering the ethical issues related to nursing and that Ethics is an integral part of the nursing education in the degree course, one would suppose that academic dishonesty might be less frequent in nursing students than in students of other disciplines. However, several studies show that this trend of deceitful behaviour seems to be similar among the university nursing students and those of other disciplines. The aim of this study is to investigate the phenomenon of academic dishonesty in the classroom from a longitudinal perspective within a cohort of Italian nursing students. A non-experimental longitudinal design was used. All nursing students were recruited from the Nursing Science Bachelor Degree Program of a big Italian university in the centre of Italy and participants were part of an ongoing longitudinal research project which started in 2011 on nursing students' wellbeing. The results show that students get accustomed to taking academically deceitful actions. They come to consider their behaviours acceptable and normal, thereby stabilizing them, which increases the probability of stabilizing subsequent deceitful behaviours. The stability through time of academic cheating behaviours committed during higher education, within the study's timeframe, provides important perspectives into the establishment of rigorous standards of ethical and moral behaviours by the students.

Nursing Student Self-efficacy in Psychomotor Skills: Findings From a Validation, Longitudinal, and Correlational Study.

Student perceptions of self-efficacy (SE) prevent stress and burnout and improve engagement in nursing education, thus increasing learning outcomes. The study aims were to (1) validate a scale measuring nursing SE in psychomotor skills (NSE-PS), (2) describe changes in NSE-PS over time, and (3) explore NSE-PS correlations with burnout and engagement. A total of 1117 nursing students participated. A significant increase in the NSE-PS scores over the years has emerged; in addition, all NSE-PS dimensions were correlated negatively with burnout and positively with engagement.

Towards an integrated model of nursing competence: an overview of the literature reviews and concept analysis.

INTRODUCTION: Competence is considered a fundamental element when measuring a nurse's or student's ability to provide nursing care, but there is no consensus on what competence really is. This paper aims to review the existing meanings and models of nursing competence. METHOD: The overview of literature reviews and concept analysis was performed through a search on Pubmed, Cinahl and PsychINFO from January 2005 to September 2014. It included key words, such as: Competence Model; Professional Competence; Nursing Competence; Competency Model; Professional Competency; Nursing Competency. RESULT: A total of 14 papers were found, coming from educational or clinical nursing field. It was possible to identify some common themes: description of competence determinants; confu- sion around the competence concept; lack in competence evaluation; lack when competence have to be operationalized. CONCLUSION: The overview results, enriched by the literature coming out from the organiza- tional studies, build the conceptual basis of an integrated model of nursing competence. More empirical research is needed to test the theoretical assumptions.

Nurse moral disengagement.

BACKGROUND: Ethics is a founding component of the nursing profession; however, nurses sometimes find it difficult to constantly adhere to the required ethical standards. There is limited knowledge about the factors that cause a committed nurse to violate standards; moral disengagement, originally developed by Bandura, is an essential variable to consider. RESEARCH OBJECTIVES: This study aimed at developing and validating a nursing moral disengagement scale and investigated how moral disengagement is associated with counterproductive and citizenship behaviour at work. RESEARCH DESIGN: The research comprised a qualitative study and a quantitative study, combining a cross-validation approach and a structural equation model. PARTICIPANTS AND RESEARCH CONTEXT: A total of 60 Italian nurses (63% female) involved in clinical work and enrolled as students in a postgraduate master's programme took part in the qualitative study. In 2012, the researchers recruited 434 nurses (76% female) from different Italian hospitals using a convenience sampling method to take part in the quantitative study. ETHICAL CONSIDERATIONS: All the organisations involved and the university gave ethical approval; all respondents participated on a voluntary basis and did not receive any form of compensation. FINDINGS: The nursing moral disengagement scale comprised a total of 22 items. Results attested the mono-dimensionality of the scale and its good psychometric properties. In addition, results highlighted a significant association between moral disengagement and both counterproductive and citizenship behaviours. DISCUSSION: Results showed that nurses sometimes resort to moral disengagement in their daily practice, bypassing moral and ethical codes that would normally prevent them from enacting behaviours that violate their norms and protocols. CONCLUSION: The nursing moral disengagement scale can complement personnel monitoring and assessment procedures already in place and provide additional information to nursing management for designing interventions aimed at increasing compliance with ethical codes by improving the quality of the nurses' work environment.