Background:In the past two decades, interest in the concept of ethical climate and in its research has increased in healthcare. Ethical climate is viewed as a type of organizational work climate, and defined as the shared perception of ethically correct behavior, and how ethical issues should be handled in the organization. Ethical climate as an important element of nursing environment has been the focus of several studies. However, scoping reviews of ethical climate research in nursing have not been conducted to (...) guide further research in this area.Objective:The purpose of this scoping review is to describe and analyze studies focusing on ethical climate in nursing environment to elicit an overall picture of the research in this field.Methods:A scoping review methodology guided by Arksey and O’Malley and Levac et al. was used. Studies were identified by conducting electronic searches on PubMed/MEDLINE, CINAHL, Web of Science Core Collection, PsycINFO, and Scopus and Philosophers’ Index databases. Of 1051 citations, 56 articles matched the inclusion criteria.Ethical considerations:This study was conducted according to good scientific guidelines.Findings:Ethical climate is a topical research area which has been explored with different methods and outcomes, in different environments, and has mainly been perceived positively. The focus of the studies was on finding associations between ethical climate and work-related factors such as job satisfaction, moral distress, and turnover intentions. Methodologically, research was rather homogeneous using quantitative, descriptive, and correlative research designs.Conclusion:Novel perspectives and more diverse methodological approaches paying attentions to issues affecting generalizability of the findings could expand our knowledge in this area. (shrink)

Background Ethical decision‑making and behavior of nurses are major factors that can affect the quality of nursing care. Moral development of nurses to making better ethical decision-making is an essential element for managing the care process. The main aim of this study was to examine and comparison the effect of training in ethical decision-making through lectures and group discussions on nurses’ moral reasoning, moral distress and moral sensitivity. Methods In this randomized clinical trial study with a pre- and post-test design, (...) 66 nurses with moral reasoning scores lower than the average of the community were randomly assigned into three equal groups (n = 22) including two experimental groups and one control group. Ethical decision-making training to experimental groups was provided through the lectures and group discussions. While, the control group did not receive any training. Data were collected using sociodemographic questionnaire, the nursing dilemma test (NDT), the moral distress scale (MDS) and the moral sensitivity questionnaire (MSQ). Unadjusted and adjusted binary logistic regression analysis was reported using the odds ratio (OR) and 95% confidence intervals. Results Adjusted regression analysis showed that the probability of increasing the nursing principle thinking (NPT) score through discussion training was significantly higher than lecture (OR: 13.078, 95% CI: 3.238–15.954, P = 0.008), as well as lecture (OR: 14.329, 95% CI: 16.171–2.005, P < 0.001) and discussion groups compared to the control group (OR: 18.01, 95% CI: 22.15–5.834, P < 0.001). The possibility of increasing moral sensitivity score through discussion training was significantly higher than lecture (OR: 10.874, 95%CI: 6.043–12.886, P = 0.005) and control group (OR: 13.077, 95%CI: 8.454–16.774, P = 0.002). Moreover, the moral distress score was significantly reduced only in the trained group compared to the control, and no significant difference was observed between the experimental groups; lecture group vs. control group (OR: 0.105, 95% CI: 0.015–0.717, P = 0.021) and discussion group vs. control group (OR: 0.089, 95% CI: 0.015–0.547, P = 0.009). Conclusions The results of this study indicate that ethical decision-making training is effective on empowerment of ethical reasoning. Whereas the group discussion was also effective on increasing the ethical sensitivity, it is recommended the training plan provided in this study to be held as workshop for all nurses in health and treatment centers and placed in curricular plan of nursing students. Registration This randomized clinical trial was registered in Iranian Registry of Clinical Trials under code (IRCT2015122116163N5) in 02/07/2016. (shrink)

Background:Spiritual development is one of the most important aspects of socialization that has attracted the attention of researchers. It is needed to train nursing student and novice nurses to provide high-quality care for patients. There is ambiguity in the definition of spiritual development and its relations, especially in the eastern countries.Research objectives::To explore the concept of spiritual development in Iranian nurses.Research design:Qualitative content analysis approach. Data were gathered from semi-structured interviews. Participants and research context: The participants were 17 Iranian Muslim (...) nurses selected using a purposeful sampling. The place of interviews was on their choice.Ethical considerations:Based on the principles of the Helsinki declaration, the focus was on preserving the participants’ autonomy, confidentiality, and anonymity. The participants were told the study purposes and trends, and their rights were emphasized; they were then asked to sign written consent forms. Formal research approval was obtained from Kerman University of Medical Sciences. Ethical approval was granted by the University Ethics Committee before the study was conducted.Findings:Three themes for spiritual development were defined: obligation to religion, commitment to ethics, and commitment to law. From the results, factors such as connection to the limitless divine power, personal and society-oriented ethical codes, and commitment to the law are proposed.Discussion:There are some differences between these findings and previous study, especially in the relation of the spirituality, religion, and law. Some studies, mostly Iranian, support these findings partially.Conclusion:The results suggest that it is better to teach nursing education based on humanistic principles, ethics, and law to the new generation of nurses to improve community health and development. More studies are needed to examine the relation between these themes. (shrink)

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. (shrink)

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 had a higher score compared to the Cyprus participants. The perceptions of nurses working in oncology units in Greece regarding the ethical climate were more positive compared to Cyprus. 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. 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. (shrink)

Background:An understanding of the ethical concerns encountered by visiting nurses in the community is needed. Yet, there is a lack of research on this topic.Objectives:The purpose of this study was to explore the ethical concerns that visiting nurses experience when caring for vulnerable older people living in a community.Design and sample:A qualitative thematic analysis was used to explore the nature of the ethical issues experienced by visiting nurses (N = 13) who care for vulnerable older people, over 65 years of (...) age, in a South Korean community.Methods:In-depth interviews were conducted with visiting nurses. Qualitative thematic analysis was used to explore the main themes of the phenomenon.Ethical considerations:This study was approved by the Institutional Review Board of Chung-Ang University Bioethics Committee in South Korea.Results:Four ethical themes emerged from the qualitative data: (a) quantitative performance rather than quality care, (b) clients being invisible, (c) tuning the level of the relationship with clients, and (d) facing the visiting nurses’ own limitations.Conclusion:This study provides a theoretical basis to understand the ethical aspects of visiting nurses’ interactions with clients, which should facilitate the development of ethical guidelines for visiting nurses to use in making ethical decisions in their practice. (shrink)