Increased technological and pharmacological interventions in patient care when patient outcomes are uncertain have been linked to the escalation in moral and ethical dilemmas experienced by health care providers in acute care settings. Health care research has shown that facilities that are able to attract and retain nursing staff in a competitive environment and provide high quality care have the capacity for nurses to process and resolve moral and ethical dilemmas. This article reports on the findings of a systematic review (...) of the empirical literature (1980 — February 2007) on the effects of unresolved moral distress and poor ethical climate on nurse turnover. Articles were sought to answer the review question: Does unresolved moral distress and a poor organizational ethical climate increase nurse turnover? Nine articles met the criteria of the review process. Although the prevailing sentiment was that poor ethical climate and moral distress caused staff turnover, definitive answers to the review question remain elusive because there are limited data that confidently support this statement. (shrink)

This article describes the development of a computerized version of a measure of ethical sensitivity to racial and gender intolerance, the Racial Ethical Sensitivity Test. The REST was based on James Rest's 4-component model of moral development and the professional codes of ethics from school-based professions. The new version, Racial and Ethical Sensitivity Test-Compact Disk, consists of 5 videotaped scenarios followed by an interactive "interview" presented on compact discs. Data from a study with 58 students provides initial validation of the (...) REST-CD. Ethical sensitivity to racial and gender intolerance in schools, as measured by the REST-CD, was moderately related to attitudes toward racial and gender equity issues in society as measured by the Quick Discrimination Index. The results provide evidence for both interrater and internal reliability of the REST-CD scores. This study also tests the hypothesized relationship between REST-CD scores and previous multicultural and ethics course work. Students with multicultural and ethics course experience have scored significantly higher on the REST-CD than students without course work. The paper-and-pencil tests are not significantly related to previous ethics/multicultural course work. In this article, we discuss the implications of the results and directions for future research. (shrink)

All nursing courses in the UK include ethics in the curriculum, although there is considerable variation in the content of ethics courses and the teaching methods used to assist the acquisition of ethical reasoning. The effectiveness of ethics courses continues to be disputed, even when the perceptions and needs of students are taken into account in their design. This longitudinal study, carried out in the UK, but with implications for nurse education in other developed countries, explored the ethical understanding of (...) nursing students and changes in their understanding and approaches to practice over their four years of training (1995-1999). The data collection tools were a questionnaire originally piloted prior to the 1995 study, from which the present study developed, and five vignettes describing ethical dilemmas in health care also piloted in 1995. Students’ thinking progressed as they became more mature as individuals and professionals, although this progress was not necessarily in the direction of greater certainty. Suggestions are made to help nurse educators to maximize the effectiveness of ethics courses in transmitting the skills of ethical reasoning. (shrink)

Within any organization (e.g. a hospital or clinic) the perception of the way things operate may vary dramatically as a function of one’s location in the organizational hierarchy as well as one’s professional discipline. Interorganizational variability depends on organizational coherence, safety, and stability. In this four-nation (Canada, Ireland, Australia, and Korea) qualitative study of 42 nurses, we explored their perception of how ethical decisions are made, the nurses’ hospital role, and the extent to which their voices were heard. These nurses (...) suggested that their voices were silenced (often voluntarily) or were not expressed in terms of ethical decision making. Finally, they perceived that their approach to ethical decision making differed from physicians. (shrink)

This empirical study investigates the effects of nine ethical climate types (self-interest, company profit, efficiency, friendship, team interest, social responsibility, personal morality, company rules and procedures, and lastly laws and professional codes) on employee work satisfaction. The ethical climate typology developed by Victor and Cullen (in W. C. Frederick (ed.) Research in Corporate Social Performance and Policy, 1987; Administrative Science Quarterly 33, 101–125, 1988) is tested on a sample of staff and managers from 62 different telecommunication firms in Turkey. The (...) results obtained from the 1174 usable questionnaires confirm the existence of nine different ethical climate types observed in western cultures in the present sample context, which is a developing Muslim country. Regarding the effects of ethical climatic factors on employee work satisfaction, self-interest climate type appears to negatively influence work satisfaction, whereas team interest, social responsibility and law and professional codes climate types are found to have positive impacts. Managerial and further research implications of the findings are discussed. (shrink)