Commentary: Nurses’ assessment of the ethical climate of a university hospital in the South of Brazil

The ethical climate of a healthcare environment is of critical importance not only to the care provided by the organisation through its staff but also the health of that organisation. This paper shows how this element of organisational culture can be assessed and therefore understood better in order to make improvements or sustain good practice. The authors define the ethical climate as ‘the healthcare professionals’ perceptions of the ethical treatment of healthcare issues and human interaction in their work environment’. They used a five-factor structured scale (the Brazilian version of the Hospital Ethical Climate Survey – HECS-BV) to investigate it over a 4-month period in the spring/summer of 2019.

The HECS-BV focuses on work relations between peers and support in care decisions, information sharing and respect for patients’ wishes, managers and their enabling abilities, the sharing and enactment of the hospital’s mission and its ability through its structures to enable autonomy and respect between physicians and nurses in care decisions. In this study of 269 nurses, undertaken before the COVID-19 pandemic, positive scores were obtained in all areas, with the one with most scope for improvement being relationships with physicians.

A healthcare organisation’s ethical climate is critical to everyone involved with that organisation, how they perceive it (internally and externally), act in it and experience it, as a provider or recipient (active or passive) of care. Being able to assess it with an instrument such as the HECS-BV allows the ‘ethical temperature’ of the organisation to be taken and moderated through attention to any one or all of the five focus areas. This means that such a nebulous, yet critical aspect of organisational culture as its ethical climate can be assessed and altered with resultant improvements.

The ethical climate of care has always been important. But it seems to me that during the pandemic many more nurses had direct contact with it, having often – almost routinely – had to grapple with ethical dilemmas and destabilised ethical climates during that time. The ethics of care and decision-making is more prominent than ever before and any protections against moral distress and injury that nurses might previously have felt through, for instance, their organisational structures have been severely rocked as nurses found themselves in unfamiliar, exceptionally challenging, and distressing situations. While the pandemic may be waning it has left many health and care systems struggling to recover in what can be a near-toxic mix of increased demand, reduced and depleted resources whether financial or human and increased expectations from governments, populations and workforces. As such, many organisations’ ethical climates need time to recuperate, and it may be that that process needs guiding through assessment and targeted sustenance.

The maintenance of the highest standards of ethical care and how to create the best ethical climate for care will remain a constant priority for nurses and nursing. This paper is a welcome foray into assessing that element of professional practice.