The effectiveness of the Ethics Quarter intervention on the ethical activity profile of nurse managers: A randomized controlled trial.

AIM: To test the effectiveness of a new ethics educational e-learning intervention, Ethics Quarter, in supporting nurse managers' ethical activity profile. BACKGROUND: Health care organisations need evidence-based ethics interventions to support nurse managers' ethical activity profile. METHODS: A parallel-group, individually randomized controlled trial was conducted in 2020. Finnish nurse managers nationwide [members of the Union of Health and Social Care Professionals in Finland (Tehy) trade union] were randomly allocated to intervention (n = 169) or control group (n = 172). The intervention group participated in the Ethics Quarter comprising twelve 15-min evidence-based educational 'quarters' spread over 6 weeks. The control group had standard organisational ethics structures. The primary and secondary outcomes were ethical activity profile and ethics knowledge, respectively. The Consolidated Standards of Reporting Trials (CONSORT) statement for study design and reporting was adopted. RESULTS: Ethical activity profile showed statistically significant differences in mean changes between the groups from baseline to 10 weeks: all five dimensions were statistically significantly higher in the intervention group compared with the control group (p = <.0001). CONCLUSION: The Ethics Quarter was effective in increasing nurse managers' ethical activity profile. IMPLICATIONS FOR NURSING MANAGEMENT: Applying this ethics educational e-learning intervention would benefit nursing management education and health care organisations. TRIAL REGISTRATION: clinicaltrials.gov: NCT04234503.

Relationships between organizational and individual support, nurses' ethical competence, ethical safety, and work satisfaction.

BACKGROUND: Organizations and nurse leaders do not always effectively support nurses' ethical competence. More information is needed about nurses' perceptions of this support and relevant factors to improve it. PURPOSE: The aim of the study was to examine relationships between nurses' perceived organizational and individual support, ethical competence, ethical safety, and work satisfaction. METHODOLOGY: A cross-sectional questionnaire survey was conducted. Questionnaires were distributed to nurses (n = 298) working in specialized, primary, or private health care in Finland. Descriptive statistics, multifactor analysis of variance, and linear regression analysis were used to test the relationships. RESULTS: The nurses reported low organizational and individual support for their ethical competence, whereas perceptions of their ethical competence, ethical safety, and work satisfaction were moderate. There were statistically significant positive correlations between both perceived individual and organizational support, and ethical competence, nurses' work satisfaction, and nurses' ethical safety. CONCLUSIONS: Organizational and individual support for nurses' ethical competence should be strengthened, at least in Finland, by providing more ethics education and addressing ethical problems in multiprofessional discussions. Findings confirm that organizational level support for ethical competence improves nurses' work satisfaction. They also show that individual level support improves nurses' sense of ethical safety, and both organizational and individual support strengthen nurses' ethical competence. PRACTICE IMPLICATIONS: These findings should assist nurse leaders to implement effective support practices to strengthen nurses' ethical competence, ethical safety, and work satisfaction.

Organisational and individual support for nurses' ethical competence: A cross-sectional survey.

BACKGROUND: Nurses' ethical competence has been identified as a significant factor governing high quality of care. However, nurses lack support in dealing with ethical problems, and therefore managerial support for nurses' ethical competence is needed. RESEARCH QUESTIONS: This study aimed to analyse, from the perspective of nurse and nurse leaders, the level of nurses' and nurse leaders' ethical competence, perceptions of support for nurses' ethical competence at the organisational and individual levels and background factors associated with this support. RESEARCH DESIGN: A descriptive, cross-sectional study design was employed. The Ethical Competence and Ethical Competence Support questionnaires were used to measure the main components. Descriptive statistics and multifactor analysis of variance were used for data analysis. PARTICIPANTS: The participants were 298 nurses and 193 nurse leaders working in specialised (48%/52%), primary (43%/36%) or private healthcare (5%/7%) in Finland. Ethical considerations: Ethical approval was obtained from the university ethics committee. RESULTS: Nurses estimated their own ethical competence to be at an average level, whereas nurse leaders estimated their own competence at a high level. Nurses' and nurse leaders' perceptions of provided support for nurses' ethical competence was not at a high level. The positive agreement percentage related to organisational support was 44% among nurses and 51% among nurse leaders. The positive agreement percentage related to individual support was lower, that is, 38% among nurses and 61% among nurse leaders. University education had a positive association with some items of individual support. CONCLUSION: Despite the findings that ethical competence was estimated at a high level among nurse leaders, perceptions of support for nurses' ethical competence were not at a satisfactory level. At the organisational level, nurse leaders need to inform of ethical procedures and practices in orientation; encourage multidisciplinary ethics discussions and collaboration; and support nurses at an individual level to participate in ethics education, multidisciplinary ethics discussions and in solving ethical problems.

Supporting ethical competence of nurses during recruitment and performance reviews - the role of the nurse leader.

AIM: The aim of this study was to analyse how nurse leaders support the ethical competence of nurses during recruitment and performance reviews. BACKGROUND: Ethical competence of nurses refers to ethical behaviour and action requiring ethical knowledge and reflection. Nurse leaders have a key role in supporting the ethical competence of nurses, but little is known about just how this should be done. METHOD: The data were collected using a structured questionnaire and analysed statistically. The target sample consisted of nurse leaders (n = 198) from two university hospitals in two healthcare districts in Finland. RESULTS: Nurse leaders support the ethical competence of nurses more often during performance reviews than during recruitment. During recruitment, nurse leaders ensure the ethical behaviour and knowledge of nurses to varying degrees. During performance reviews, nurse leaders ensure that nurses meet the requirements for collegiality and comply with ethical guidelines and that they do so according to nursing values and principles. CONCLUSIONS: There seems to be a need to examine and improve support for the ethical competence of nurses, both during recruitment and performance reviews. Future priorities should include a focus on supporting the ethical knowledge, reflection and behaviour of nurses. IMPLICATIONS FOR NURSING MANAGEMENT: An important aspect in terms of supporting the ethical competence of nurses has to do with the ethical knowledge and education of nurse leaders and organisational policies or recommendations for ethical support.

A mixed-method systematic review: support for ethical competence of nurses.

AIM: The aim was to appraise and synthesize evidence of empirical studies of how nurses' ethical competence can be supported. BACKGROUND: Ethical competence is an essential element of nursing practice. Nurses increasingly need support in competence when carrying out their responsibilities towards their patients. DESIGN: A mixed-method systematic review of quantitative and qualitative studies was undertaken according to the University of York's Centre for Reviews and Dissemination guidelines. DATA SOURCES: Searches of MEDLINE, Nursing Database and British Nursing Index databases were conducted, yielding 512 citations between 1985-2012. METHODS: After a two-stage application of inclusion and exclusion criteria, 34 articles were included. The quality of the studies was assessed using STROBE or COREQ criteria. Data were analysed by content analysis. RESULTS: Nurses' ethical competence has been studied from different viewpoints: ethical decision-making, ethical sensitivity, ethical knowledge and ethical reflection. There was little empirical evidence of provided support, but studies offered recommendations on how to support ethical competence. The most common strategies to support ethical competence were ethics education, ethics rounds, ethics committee and consultation. Nurse leaders and colleagues have a key role in providing opportunities for nurses to gain ethical competence. CONCLUSIONS: There is a need to develop evidence-based support at the organizational and individual level to support nurses' ethical competence. Barriers for multiprofessional cooperation in ethical issues should be recognized and addressed as part of the development of organizational ethical practices. Research should pay more attention to the conceptual, theoretical and practical perspectives of ethical competence.