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. (shrink)

Objective Moral distress is a complex phenomenon experienced by healthcare professionals. This study examined the relationships between key dimensions of Organizational Culture in Healthcare (OCHC)—perceived psychological safety, ethical climate, patient safety—and healthcare professionals’ perception of moral distress.Design Cross-sectional surveySetting Pediatric and adult critical care medicine, and adult hospital medicine healthcare professionals in the United States.Participants Physicians (n = 260), nurses (n = 256), and advanced practice providers (n = 110) participated in the study.Main outcome measures Three dimensions of OCHC were (...) measured using validated questionnaires: Olson’s Hospital Ethical Climate Survey, Agency for Healthcare Research and Quality’s Patient Safety Culture Survey, and Edmondson’s Team Psychological Safety Survey. The perception of moral distress was measured using the Moral Distress Amidst a Pandemic Survey. The hypothesized relationships between various dimensions were tested with structural equation modeling (SEM).Results Adequate model fit was achieved in the SEM: a root-mean-square error of approximation =0.072 (90% CI 0.069 to 0.075), standardized root mean square residual = 0.056, and comparative fit index =0.926. Perceived psychological safety (β= −0.357, p <.001) and patient safety culture (β = −0.428, p<.001) were negatively related to moral distress experience. There was no significant association between ethical climate and moral distress (β = 0.106, p = 0.319). Ethical Climate, however, was highly correlated with Patient Safety Culture (factor correlation= 0.82).Conclusions We used structural equation model to test a theoretical model of multi-dimensional organizational culture and healthcare climate (OCHC) and moral distress.Significant associations were found, supporting mitigating strategies to optimize psychological safety and patient safety culture to address moral distress among healthcare professionals. Future initiatives and studies should account for key dimensions of OCHC with multi-pronged targets to preserve the moral well-being of individuals, teams, and organizations. (shrink)

Background Education is a tool for the promotion of ethical skills that ensure the principles of conduct and the quality of care provided. The literature is still incipient in this theme; however, some studies point to education and ethical consultations as strategies to promote an ethical environment. Objective To map the interventions that aim to prospect the ethical environment in health services. Method Scoping review to answer the question “What interventions are being used by health professionals to prospect an ethical (...) environment in health services?” It occurred in the Medline (PubMed), CINAHL with Full Text (EBSCO), Scopus, Embase (Elsevier), and Web of Science databases in January 2023 by two reviewers, via the Rayyan platform. Articles with health professionals addressing interventions to prospect the ethical environment in any health service were included, without time frame. A form was used for data extraction and analysis occurred via Bardin content analysis. The review protocol was registered in the Open Science Framework. Results 2429 records were found; however, only 12 articles were included for analysis, these being randomized, cross-sectional, descriptive, and qualitative studies. Among the interventions, it was noticed that 58.3% ( n = 7) is about ethical education, 16.7% ( n = 2) about ethical guidelines and codes, 16.7% ( n = 2) about ethical reflection and leadership, and 8.3% ( n = 1) of ethical consultations. A theoretical map was elaborated, and four types of interventions were identified, based on ethical consultation, ethical education, guidelines and codes of ethics, reflection, and ethical leadership. Conclusions The interventions were considered effective to prospect the ethical environment in health services, and their effectiveness was evaluated by validated instruments, as well as through interviews and focus groups. (shrink)