Factors of Hospital Ethical Climate among Hospital Nurses in Korea: A Systematic Review and Meta-Analysis.

In the current healthcare landscape, nurses frequently encounter various ethical dilemmas, necessitating situation-specific ethical judgments. It is crucial to thoroughly understand the factors that shape the hospital ethical climate and the elements that are influenced by this climate. This study aims to identify the variables associated with the hospital ethical climate perceived by Korean nurses. A literature search was conducted using the core database, and the effect sizes of relevant variables were analyzed using a comprehensive meta-analysis. The overall effect size analysis incorporated 56 variables, and a meta-analysis was performed on 7 variables. This study found correlations between ethical sensitivity (ESr = 0.48), moral distress (ESr = -0.30), empathy (ESr = 0.27), ethical leadership (ESr = 0.72), job satisfaction (ESr = 0.64), and intention to leave (ESr = -0.34) with the hospital ethical climate. Both personal and organizational attributes were moderately related to the hospital ethical climate. Enhancing the hospital ethical climate could positively affect both individuals and the organization. The protocol for this study has been registered with PROSPERO (CRD42022379812).

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.

Correlation Analysis between Moral Courage of ICU Nurses and Hospital Ethical Climate / 中国医学伦理学

【Objective:】 To explore the relationship between the moral courage of nurses in Intensive Care Unit (ICU) and the hospital ethical climate, and to provide a theoretical basis for enhancing the moral courage of ICU nurses. 【Methods:】 A total of 468 ICU nurses from 8 tertiary A hospitals in Shaanxi Province were selected as the subjects by convenience sampling method, and the General Information Form, Hospital Ethical Climate Survey, and Nurses’ Moral Courage Scale were used for the questionnaire survey. 【Results:】 A total of 468 questionnaires were distributed and 463 valid questionnaires were returned, with an effective recovery rate of 98.93%. The score of hospital ethical climate for ICU nurses was (100.69±19.76), and the score of moral courage was (83.67±15.48). There was a positive correlation between hospital ethical climate and moral courage (r=0.866, P<0.001). Hierarchical multiple regression analysis showed that hospital ethical climate entered the influencing factor model of ICU nurses’ moral courage, which can independently explain 57% of the variation in ICU nurses’ moral courage. 【Conclusion:】 The moral courage of ICU nurses was at a medium level, and positively correlated with the hospital ethical climate, that is, the better the hospital ethical climate perceived by ICU nurses, the higher their level of moral courage. Nursing managers should focus on deepening the hospital ethical climate, and enhance the level of hospital ethical climate through scientific methods to promote the improvement of ICU nurses’ moral courage.

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.

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.

BACKGROUND: The COVID-19 pandemic called for a new ethical climate in the designated hospitals and imposed challenges on care quality for anti-pandemic nurses. Less was known about whether hospital ethical climate and nurses' ethical sensitivity were associated with care quality. This study examined the association between the perceived hospital ethical climate and self-evaluated quality of care for COVID-19 patients among anti-pandemic nurses, and explored the mediating role of ethical sensitivity in this relationship. METHODS: A cross-sectional study was conducted through an online survey. A total of 399 anti-pandemic nurses from ten designated hospitals in three provinces of China were recruited to fill out an online survey. Multiple linear regression analysis and a bootstrap test were used to examine the relationships between ethical climate, ethical sensitivity and care quality. RESULTS: Nurses reported mean scores of 4.43 ± 0.577 (out of 5) for hospital ethical climate, 45.00 ± 7.085 (out of 54) for ethical sensitivity, and 5.35 ± 0.661 (out of 6) for self-evaluated care quality. After controlling for covariates, perceived hospital ethical climate was positively associated with self-evaluated care quality (direct effect = 0.710, 95% confidence interval [CI] 0.628, 0.792), and was partly mediated by ethical sensitivity (indirect effect = 0.078, 95% confidence interval [CI] 0.002, 0.145). CONCLUSIONS: Chinese nurses who cared for COVID-19 patients perceived high levels of hospital ethical climate, ethical sensitivity, and self-evaluated care quality. Positive perceptions of hospital ethical climate were both directly associated with a higher level of self-evaluated care quality and indirectly associated, through the mediation effect of ethical sensitivity among anti-pandemic nurses.

Investigating the relationship between the ethical atmosphere of the hospital and the ethical behavior of Iranian nurses.

BACKGROUND: The ethical guidelines and ethical atmosphere of the hospital affect the quality of nursing care. Improving the health of patients in most cases depends on the observance of ethical points and ethical behaviors by nurses. The aim of this study was to determine the effect of hospital ethics and ethical training guidelines on improving the quality of nursing care and nurses' professional ethics. MATERIALS AND METHODS: This is a descriptive-analytical study. This study was performed by multi-stage relative cluster sampling on 260 qualified nurses in 2014. Data were collected using the Hospital Ethical Climate Questionnaire and the Judgments about Nursing Decisions Questionnaire and analyzed using SPSS software version 19. RESULTS: The results showed that nurses' perceptions of the ethical climate of hospitals were relatively positive. The ethical behavior of nurses was moderate and good. Nurses' perception of the ethical climate scores was not related to the ideal ethical behavior of nurses (r = 0.11, P = 0.86). The ethical climate perceptions of nurses were related to real workplace ethical behavior score (r = 0.188, P = 0.002). The results also showed that ethical guidelines can improve the quality of nursing care. CONCLUSION: Considering the results of this study, it seems that holding nursing ethics training programs can be a big step toward promoting the professional behavior of nurses and the observance of professional ethics by nurses.

Greek Nurses' Perception of Hospital Ethical Climate: A Cross-Sectional Study.

This study aimed to examine Greek nurses' perceptions about hospital ethical climate and to investigate the possible difference of those perceptions regarding their demographic and work-related characteristics. The cross-sectional study design was employed in this study in which 286 nurses and nurse assistants participated. Data were collected by a sheet containing demographic and work-related characteristics and the Greek version of the Oslons' Hospital Ethical Climate Scale. IBM Statistical Package for Social Sciences 25 was used in data analysis. Frequencies, means, percentages, and standard deviations summarized the data. For the statistical differences, parametric tests were performed. Independent Samples t and Pearson correlation analysis were used to determine the relationship between the ethical climate of the hospital and the nurses' characteristics. The p-values 0.05 were considered statistically significant. The mean age of the nurses was 44 years (SD: 8.5 years; range 24-66 years). The majority of them were women (77.3%). A percent of 57.7% of the sample was married. Most positive perceptions were concerning managers (4.01) following by peers (3.82), patients (3.69), hospitals (3.29) while the least positive perceptions of the ethical climate were concerning the physicians (3.16). The factors associated with hospital ethical perception were: working experience and responsible position. The highest score of ethical climate reported to managers subscale, while the minimum score was related to physicians. In general, Greek nurses reported positive perceptions regarding hospital ethical climate. The positive ethical climate is associated with a better working environment, fewer nurses' experience of moral distress, fewer chances for nursing turnover, high quality of nursing care, and fewer errors in nursing practice.

Influence of hospital ethical climate on the turnover intention and job embeddedness of nurses / 中国职业医学

OBJECTIVE: To explore the influence of hospital ethical climate on the turnover intention and the mediating role of job embeddedness of nurses. METHODS: Totally 468 clinical nurses from there public general hospitals in Zhengzhou City were selected as the research subjects using convenience sampling method. The Hospital Ethical Climate Survey, Job Embeddedness Scale and Turnover Intention Questionnaire were used to investigate the scores of hospital ethical climate, job embeddedness and resignation intention respectively. RESULTS: The mean scores of hospital ethical climate, job embeddedness and turnover intention were(3.5±0.4),(2.8±0.3) and(2.8±0.7) respectively. The turnover intention of nurses was negatively associated with hospital ethical climate and job embeddedness [correlation coefficient(r)=-0.67,-0.60, all P<0.01]. The results of multiple linear regression analysis showed that the higher the scores of hospital ethical climate and job embeddedness, the lower the score of turnover intention of nurses(all P<0.01), after adjusting confounding factors such as length of service, educational level, professional title and personnel employment. The structural equation analysis results showed that job embeddedness played a part of the mediating role between the hospital ethical climate and the turnover intention of nurses and the mediating efficacy accounted for 23.3% of the total efficacy. CONCLUSION: The hospital ethical climate has a significant negative effect on the turnover intention, and job embeddedness has an intermediary effect between them.

Validation of the Iranian Version of the Hospital Ethical Climate Survey.

BACKGROUND AND PURPOSE: The aim of this study was to determine validation of the Iranian version of the Hospital Ethical Climate Survey (HECS). METHODS: This is a methodological study with a cross-sectional design that was conducted in 2016. A forward-backward translation method was used to translate the questionnaire from English to Persian and face, content, and construct validity as well as reliability were assessed. RESULTS: The factor structure of the HECS through explorative Principal Component Analysis (PCA) confirmed five factors that explained 64.7% of total variance. The overall Cronbach's alpha coefficient was .86 and the Cronbach's alphas for five of the subscales were between .63 and .92. CONCLUSIONS: The Iranian version of HECS has adequate validity and reliability for measuring the hospital ethical climate in the Iraniansociety.

Cancer nurses' perceptions of ethical climate in Greece and Cyprus.

BACKGROUND: In recent years, the interest in ethical climate has increased in the literature. However, there is limited understanding of the phenomenon within the cancer care context as well as between countries. AIM: To evaluate cancer nurses' perceptions of hospital ethical climate in Greece and Cyprus. RESEARCH DESIGN: This was a quantitative descriptive-correlational comparative study with cancer nurses. Data were collected with the Greek version of the Hospital Ethical Climate Survey questionnaire in addition to demographic data. PARTICIPANTS AND RESEARCH CONTEXT: In total, n = 235 cancer nurses working in cancer care settings in Greece and Cyprus were recruited at two national oncology nursing conferences. ETHICAL CONSIDERATIONS: The study conforms to the principles of the World Medical Association Declaration of Helsinki and the relevant ethical approvals were obtained according to national law. RESULTS: The results showed that in terms of the "Managers" dimension, participants working in Greek hospitals (4.30 ± 0.73) had a higher score compared to the Cyprus participants (3.66 ± 0.93) (t = -5.777, p ≤ 0.001). The perceptions of nurses working in oncology units in Greece regarding the ethical climate were more positive compared to Cyprus (M = 3.67 for Greece and M = 3.53 for Cyprus, p ≤ 0.001). Nurses with a higher level of education had a lower average ethical climate score across all dimensions. All dimensions exhibit positive and moderate to high correlations between them (r = 0.414-0.728, p < 0.01). CONCLUSION: It is imperative to evaluate and improve the hospital ethical climate that prevails in each cancer care department. This highlights the fact that nurses working in seemingly similar cultural and organizational contexts might still have different perceptions of the ethical climate. Despite these differences, it is necessary to create the right conditions to address ethical issues. A positive ethical climate requires good relationships between healthcare professionals and the presence of good teamwork in order to ensure better healthcare provision.

Translating and culturally adapting the shortened version of the Hospital Ethical Climate Survey (HECS-S) - retaining or modifying validated instruments.

BACKGROUND: The Hospital Ethical Climate Survey (HECS) was developed in the USA and later shortened (HECS-S). HECS has previously been translated into Swedish and the aim of this study was to describe a process of translating and culturally adapting HECS-S and to develop a Swedish multi-professional version, relevant for paediatrics. Another aim was to describe decisions about retaining versus modifying the questionnaire in order to keep the Swedish version as close as possible to the original while achieving a good functional level and trustworthiness. METHODS: In HECS-S, the respondents are asked to indicate the veracity of statements. In HECS and HECS-S the labels of the scale range from 'almost never true' to 'almost always true'; while the Swedish HECS labels range from 'never' to 'always'. The procedure of translating and culturally adapting the Swedish version followed the scientific structure of guidelines. Three focus group interviews and three cognitive interviews were conducted with healthcare professionals. Furthermore, descriptive data were used from a previous study with healthcare professionals (n = 89), employing a modified Swedish HECS. Decisions on retaining or modifying items were made in a review group. RESULTS: The Swedish HECS-S consists of 21 items including all 14 items from HECS-S and items added to develop a multi-professional version, relevant for paediatrics. The descriptive data showed that few respondents selected 'never' and 'always'. To obtain a more even distribution of responses and keep Swedish HECS-S close to HECS-S, the original labels were retained. Linguistic adjustments were made to retain the intended meaning of the original items. The word 'respect' was used in HECS-S with two different meanings and was replaced in one of these because participants were concerned that respecting patients' wishes implied always complying with them. CONCLUSIONS: The process of developing a Swedish HECS-S included decisions on whether to retain or modify. Only minor adjustments were needed to achieve a good functional level and trustworthiness although some items needed to be added. Adjustments made could be used to also improve the English HECS-S. The results shed further light on the need to continuously evaluate even validated instruments and adapt them before use.

Nurses' perception of ethical climate at a large academic medical center.

BACKGROUND: Nurses are confronted daily with ethical issues while providing patient care. Hospital ethical climates can affect nurses' job satisfaction, organizational commitment, retention, and physician collaboration. PURPOSE: At a metropolitan academic medical center, we examined nurses' perceptions of the ethical climate and relationships among ethical climate factors and nurse characteristics. DESIGN/PARTICIPANTS: We used a descriptive correlational design and nurses ( N = 475) completed Olson's Hospital Ethical Climate Survey. Data were analyzed using STATA. Ethical considerations: Approvals by the Nursing Research Council and Institutional Review Board were obtained; participants' rights were protected. RESULTS: Nurses reported an ethical climate total mean score of 3.22 ± 0.65 that varied across factors; significant differences were found for ethical climate scores by nurses' age, race, and specialty area. CONCLUSION: These findings contribute to what is known about ethical climate and nurses' characteristics and provides the foundation to develop strategies to improve the ethical climate in work settings.