Ethical climate,moral resilience,and ethical competence of head nurses

Abstract

Background

The ethical competence of head nurses plays a pivotal role in nursing ethics. Ethical climate is a prerequisite for ethical competence, and moral resilience can positively influence an individual’s ethical competence. However, few studies have focused on the relationship between ethical climate, moral resilience, and ethical competence among them.

Objectives

To investigate the relationship between ethical climate, moral resilience, and ethical competence, and examine the mediating role of moral resilience between ethical climate and ethical competence among head nurses.

Design

A quantitative, cross-sectional study.

Methods

A total of 309 Chinese head nurses completed an online survey, including ethical climate questionnaire, Rushton moral resilience scale, and ethical competence questionnaire. Inferential statistical analysis includes Pearson’s correlation and a structural equation model.

Ethical considerations

This study received ethical approval from the Institutional Review Board of Xiangya Nursing School of Central South University (No. E2023146).

Results

Head nurses’ ethical climate score positively impacted ethical competence (r = 0.208, p < .001), and ethical climate could affect ethical competence through the mediating role of moral resilience.

Conclusion

This study emphasized the value of ethical climate in moral resilience of head nurses, ultimately leading to an enhancement in their ethical competence.

Keywords

Ethical climate moral resilience ethical competence head nurses mediating effect

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References

Ganz

Wagner

Toren

. Nurse middle manager ethical dilemmas and moral distress. Nurs Ethics 2015; 22: 43–51. DOI: 10.1177/0969733013515490.

Lin

Zhang

, et al. Advancements in the research on ethical competence of healthcare professionals. J Nurs 2022; 37: 106–109.

Kulju

Stolt

Suhonen

, et al. Ethical competence: a concept analysis. Nurs Ethics 2016; 23: 401–412. DOI: 10.1177/0969733014567025.

Cannaerts

Gastmans

Dierckx de Casterlé

. Contribution of ethics education to the ethical competence of nursing students: educators' and students' perceptions. Nurs Ethics 2014; 21: 861–878. DOI: 10.1177/0969733014523166.

Choe

Kwon

Kim

. How do ethically competent nurses behave in clinical nursing practice? A qualitative study. J Nurs Manag 2022; 30: 4461–4471. DOI: 10.1111/jonm.13884.

Aung

Tewogbola

. The impact of emotional labor on the health in the workplace: a narrative review of literature from 2013-2018. AIMS Public Health 2019; 6: 268–275. DOI: 10.3934/publichealth.2019.3.268.

Robichaux

. Ethical competence in nursing practice: competencies, skills, decision-making. Berlin, Germany: Springer Publishing Company, 2016.

Ulrich

O’donnell

Taylor

, et al. Ethical climate, ethics stress, and the job satisfaction of nurses and social workers in the United States. Soc Sci Med 2007; 65: 1708–1719.

Martin

Cullen

. Continuities and extensions of ethical climate theory: a meta-analytic review. J Bus Ethics 2006; 69: 175–194.

10.

Rest

. Moral development in the professions: psychology and applied ethics. London, UK: Psychology Press, 1994.

11.

Rushton

. Cultivating moral resilience. Am J Nurs 2017; 117: S11–S15.

12.

Luo

Jiang

, et al. Research progress on hospital nursing human resources capacity planning and control. Ind Eng Manag 2023; 28: 184–198. DOI: 10.19495/j.cnki.1007-5429.2023.05.019.

13.

Zydziunaite

Lepaite

Suominen

. Leadership styles in ethical dilemmas when head nurses make decisions. Int Nurs Rev 2013; 60: 228–235. DOI: 10.1111/inr.12018.

14.

Andersson

Olsson

. Mellanchefer inom vård och omsorg - om tolkningsutrymme av yrkesrollen och ledarskap i en politiskt styrd organisation. School of Social Work 2013; 38: 95–98.

15.

Moynihan

Taylor

Crowe

, et al. Ethical climate in contemporary paediatric intensive care. J Med Ethics 2021; 47: e14. DOI: 10.1136/medethics-2020-106818.

16.

Vryonides

Papastavrou

Charalambous

, et al. Ethical climate and missed nursing care in cancer care units. Nurs Ethics 2018; 25: 707–723.

17.

Zhang

Gong

, et al. Effects of ethical leadership on nurses’ service behaviors. Nurs Ethics 2019; 26: 1861–1872.

18.

Dinc

Huric

. The impact of ethical climate types on nurses’ behaviors in Bosnia and Herzegovina. Nurs Ethics 2017; 24: 922–935.

19.

Borhani

Jalali

Abbaszadeh

, et al. Nurses’ perception of ethical climate and organizational commitment. Nurs Ethics 2014; 21: 278–288.

20.

Mayer

Kuenzi

Greenbaum

. Examining the link between ethical leadership and employee misconduct: the mediating role of ethical climate. J Bus Ethics 2010; 95: 7–16. DOI: 10.1007/s10551-011-0794-0.

21.

Chalmers

. Nurse managers' ethical conflict with their health care organizations: a New Zealand perspective. Palmerston North: Massey University, 2008.

22.

Gaudine

Beaton

. Employed to go against one's values: nurse managers' accounts of ethical conflict with their organizations. Can J Nurs Res 2002; 34: 17–34.

23.

Zheng

Zhang

, et al. Moral resilience and its influencing factors among ICU nurses. Journal of Nursing Science 2023; 38: 95–98.

24.

Spilg

Rushton

Phillips

, et al. The new frontline: exploring the links between moral distress, moral resilience and mental health in healthcare workers during the COVID-19 pandemic. BMC Psychiatr 2022; 22: 19–20. DOI: 10.1186/s12888-021-03637-w.

25.

Young

Rushton

. A concept analysis of moral resilience. Nurs Outlook 2017; 65: 579–587. DOI: 10.1016/j.outlook.2017.03.009.

26.

Holtz

Heinze

Rushton

. Interprofessionals’ definitions of moral resilience. J Clin Nurs 2018; 27: e488–e494. DOI: 10.1111/jocn.13989.

27.

Aitamaa

Leino-Kilpi

Iltanen

, et al. Ethical problems in nursing management: the views of nurse managers. Nurs Ethics 2016; 23: 646–658.

28.

Rushton

. Principled moral outrage: an antidote to moral distress? AACN Adv Crit Care 2013; 24: 82–89.

29.

Antonsdottir

Rushton

Nelson

, et al. Burnout and moral resilience in interdisciplinary healthcare professionals. J Clin Nurs 2022; 31: 196–208. DOI: 10.1111/jocn.15896.

30.

Shuo

Yaxuan

Xinyuan

, et al. Research progress and lmplications of oversea nurses' moral resilience. Medicine & Philosophy 2022; 43: 51–54.

31.

Reid

Infirmières

Nightingale

FIF

, et al. Nursing human resources planning and management competencies. Switzerland: International Council of Nurses Geneva, 2010.

32.

Association CN and Association HCPCCLC . Chinese code of ethics for nurses. Chinese Medical Ethics 2020; 33: 1232–1233.

33.

Koskenvuori

Stolt

Suhonen

, et al. Healthcare professionals’ ethical competence: a scoping review. Nursing Open 2019; 6: 5–17. DOI: 10.1002/nop2.173.

34.

Höglund

Eriksson

Helgesson

. The role of guidelines in ethical competence-building: perceptions among research nurses and physicians. Clin Ethics 2010; 5: 95–102.

35.

Barkhordari-Sharifabad

Ashktorab

Atashzadeh-Shoorideh

. Ethical leadership outcomes in nursing: a qualitative study. Nurs Ethics 2018; 25: 1051–1063.

36.

Salmela

Koskinen

Eriksson

. Nurse leaders as managers of ethically sustainable caring cultures. J Adv Nurs 2017; 73: 871–882. DOI: 10.1111/jan.13184.

37.

Storch

Schick Makaroff

Pauly

, et al. Take me to my leader: the importance of ethical leadership among formal nurse leaders. Nurs Ethics 2013; 20: 150-157. DOI: 10.1177/0969733012474291.

38.

Barkhordari-Sharifabad

Ashktorab

Atashzadeh-Shoorideh

. Obstacles and problems of ethical leadership from the perspective of nursing leaders: a qualitative content analysis. J Med Ethics Hist Med 2017; 10: 1.

39.

Commission MH . Overview of Changsha medical resources in 2022, 2022. https://wsjkw.changsha.gov.cn/zfxxgk/fdzdgknr/tjxx/202303/t20230328_11042738.html

40.

Kline

. Principles and practice of structural equation modeling. New York: Guilford Publications, 2023.

41.

Victor

Cullen

. The organizational bases of ethical work climates. Adm Sci Q 1988; 33: 101–125. DOI: 10.2307/2392857.

42.

Zhang

, et al. Latent profiles of ethical climate and nurses' service behavior. Nurs Ethics 2023; 30: 626–641. DOI: 10.1177/09697330231160008.

43.

Heinze

Hanson

Holtz

, et al. Measuring health care interprofessionals' moral resilience: validation of the Rushton moral resilience scale. J Palliat Med 2021; 24: 865–872. DOI: 10.1089/jpm.2020.0328.

44.

Pan

, et al. Study on the current situation and influencing factors of uncivil behavior encountered by nurses in oncology hospitals. Nurs J 2023; 38: 10–13.

45.

Poikkeus

Suhonen

Katajisto

, et al. Organisational and individual support for nurses’ ethical competence: a cross-sectional survey. Nurs Ethics 2018; 25: 376–392. DOI: 10.1177/0969733016642627.

46.

De Schrijver

Maesschalck

. A new definition and conceptualization of ethical competence. Achieving ethical competence for public service leadership 2013; 29: 51.

47.

Curran

. Methods for the detection of carelessly invalid responses in survey data. J Exp Soc Psychol 2016; 66: 4–19.

48.

Brown

. Confirmatory factor analysis for applied research. New York: Guilford Publications, 2015.

49.

Byrne

. Structural equation modeling with AMOS: basic concepts, applications, and programming. Lodnon, UK: Psychology Press, 2016.

50.

Zhang

Gong

Z-X

, et al. Ethical climate and service behaviours in nurses: the moderating role of employment type. J Adv Nurs 2019; 75: 1868–1876. DOI: 10.1111/jan.13961.

51.

Huang

C-C

You

C-S

Tsai

M-T

. A multidimensional analysis of ethical climate, job satisfaction, organizational commitment, and organizational citizenship behaviors. Nurs Ethics 2012; 19: 513–529. DOI: 10.1177/0969733011433923.

52.

Chen

Yang

Gao

, et al. Impact of satisfactions with psychological reward and pay on Chinese nurses' work attitudes. Appl Nurs Res 2015; 28: e29–e34. DOI: 10.1016/j.apnr.2015.03.002.

53.

Cantu

. Physical therapists' ethical dilemmas in treatment, coding, and billing for rehabilitation services in skilled nursing facilities: a mixed-method pilot study. J Am Med Dir Assoc 2019; 20: 1458–1461. DOI: 10.1016/j.jamda.2019.06.013.

54.

Berdida

DJE

. The mediating roles of moral courage and moral resilience between nurses’ moral distress and moral injury: an online cross-sectional study. Nurse Educ Pract 2023; 71: 103730. DOI: 10.1016/j.nepr.2023.103730.

55.

Brewer

Ziegler

Kurdian

, et al. Relationships of individual and workplace characteristics with nurses’ moral resilience. Nurs Ethics 2023; 27: 096973302311616. DOI: 10.1177/09697330231161692.

56.

Olson

Bao

Parayitam

. Political behavior, trustworthiness, job satisfaction, and commitment: an empirical study. Chin Manag Stud 2014; 8: 354–374.

57.

Hauhio

Leino-Kilpi

Katajisto

, et al. Nurses’ self-assessed moral courage and related socio-demographic factors. Nurs Ethics 2021; 28: 1402–1415.

58.

Hossain

Clatty

. Self-care strategies in response to nurses’ moral injury during COVID-19 pandemic. Nurs Ethics 2021; 28: 23–32. DOI: 10.1177/0969733020961825.

59.

Poikkeus

Suhonen

Katajisto

, et al. Relationships between organizational and individual support, nurses’ ethical competence, ethical safety, and work satisfaction. Health Care Manag Rev 2020; 45: 83–93.

60.

Wang

Y-X

Yang

Y-J

Wang

, et al. The mediating role of inclusive leadership: work engagement and innovative behaviour among Chinese head nurses. J Nurs Manag 2019; 27: 688–696. DOI: 10.1111/jonm.12754.

61.

Suvarnakich

Montrikul Na Ayudhaya

. Compliance with the ethical competence framework by head nurses. Nurs Ethics 2022; 29: 1304–1317. DOI: 10.1177/09697330221105634.

62.

Molewijk

Verkerk

Milius

, et al. Implementing moral case deliberation in a psychiatric hospital: process and outcome. Med Health Care Philos 2008; 11: 43–56.

63.

Rushton

Swoboda

Reimer

, et al. The mindful ethical practice and resilience academy: sustainability of impact. Am J Crit Care 2023; 32: 184–194. DOI: 10.4037/ajcc2023236.

64.

Koskenvuori

Numminen

Suhonen

. Ethical climate in nursing environment: a scoping review. Nurs Ethics 2019; 26: 327–345. DOI: 10.1177/0969733017712081.

65.

Zhang

Zhuang

. A review on nurses’moral resilience. Journal of Nursing Science. 2022; 37: 16–19.

66.

Connor

Davidson

. Development of a new resilience scale: the Connor‐Davidson resilience scale (CD‐RISC). Depress Anxiety 2003; 18: 76–82.

67.

Bawuro

Danjuma

Wajiga

. Factors influencing innovative behaviour of teachers in secondary schools in the north east of Nigeria. PoS 2018; 4: 1007–1017.

68.

Burston

Tuckett

. Moral distress in nursing: contributing factors, outcomes and interventions. Nurs Ethics 2013; 20: 312–324.

69.

Musto

Rodney

Vanderheide

. Toward interventions to address moral distress: navigating structure and agency. Nurs Ethics 2015; 22: 91–102.

70.

Wongkhong

Wachrakul

Thawinkan

, et al. Factors affecting ethical competence of primary school administrators: a multi-level structural equation modelling. MOJEM: Malays Online J Educ Manag 2023; 11: 16–27.

71.

Gok

Babalola

Lakshman

, et al. Enhancing employees' duty orientation and moral potency: dual mechanisms linking ethical psychological climate to ethically focused proactive behaviors. J Organ Behav 2023; 44: 157–175.

72.

Ventovaara

Sandeberg

Räsänen

, et al. Ethical climate and moral distress in paediatric oncology nursing. Nurs Ethics 2021; 28: 1061–1072. DOI: 10.1177/0969733021994169.

73.

Poikkeus

Numminen

Suhonen

, et al. A mixed-method systematic review: support for ethical competence of nurses. J Adv Nurs 2014; 70: 256–271. DOI: 10.1111/jan.12213.

74.

Eriksson

Helgesson

Höglund

. Being, doing, and knowing: developing ethical competence in health care. J Acad Ethics 2007; 5: 207–216.

75.

Heres

Lasthuizen

. From ethical competence to ethical leadership. Achieving ethical competence for public service leadership. London, UK: Routledge, 2014, pp. 63–82.

76.

Aronson

. Integrating leadership styles and ethical perspectives. Can J Adm Sci 2001; 18: 244–256.

77.

Karami

PoorKarimi

. Review and clarify ethical leadership and its dimensions Case Study: employees of University of Tehran. Publ Pol Adm 2016; 7: 17–34.