Volume 34, Issue 133 (December 2021)                   IJN 2021, 34(133): 28-39 | Back to browse issues page


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Fazljoo S E, Nasiriani K, Zamani N, Azimpor S. Nurses' Perceptions of Ethical Climate, Ethical Reasoning, and Moral Courage in the Hospital. IJN 2021; 34 (133) :28-39
URL: http://ijn.iums.ac.ir/article-1-3163-en.html
1- Department of Nursing, Meybod School of Nursing, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. , efazljooo@gmail.com
2- Department of Nursing, Nursing and Midwifery Care Research Center, Maternal and Child Health Research Center, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
3- Student Research Committee, Meybod School of Nursing, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
4- Intensive Care Unit, Ziaei Ardakan Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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1. Introduction
During clinical service, every Iranian nurse faces at least one or more job conflicts, such as job dissatisfaction, poor economic and social status, lack of medical staff, long-term commitment to work in care organizations, and ethical environment. Facing improper care or moral climate determines the ethical atmosphere of an organization. Ethical standards determine to what extent ethical principles are observed in that organization and how many decisions are made according to these standards. The ethical atmosphere can be examined through employees' perception of the organizational climate, how employees make decisions when faced with ethical problems, and the degree of employee participation in solving ethical issues. So depending on what ethical atmosphere nurses are working in, it affects their attitudes toward moral issues and their moral decisions. The ethical climate helps the nurses to promote their moral reasoning by sharing in the decision-making and responsibility for the consequences of their actions. Also, the moral atmosphere creates opportunities for collective participation in problem-solving, which leads to higher levels of moral reasoning. Although it is important to have an ethical approach to issues and the ability to make decisions based on ethical reasoning, moral courage and the support of the organization's managers are required for responding correctly to situations and overcoming fear. There was no study on measuring the relationship between the moral atmosphere, moral courage, and moral reasoning in Iran. So the present study was conducted to investigate the moral atmosphere prevailing at work and its relationship with nurses' ethical reasoning and courage.
2. Materials and Methods
This research is a cross-sectional descriptive study performed on 87 nurses working in Meybod and Ardakan hospitals in 2020. The samples were selected by the available sampling method. To collect the data, we used the Hospital Ethical Climate Survey (HECS), Nursing Dilemmas Test (NDT), and Professional Moral Courage (PMC). The obtained data were analyzed by descriptive and inferential statistics (Pearson, independent t-test) in SPSS version 16.
3. Results
The age range of the participants was 24 to 50 years with a Mean±SD of 32.97±7.26 years. Their Mean±SD scores of ethics, moral reasoning, and moral courage were 83.72 ±17.42, 45.00±6.91, and 45.55±6.04, respectively. There was a significant difference between gender and perception of the moral atmosphere (P=0.03). But other individual characteristics of nurses were not significantly different from the studied variables (P<0.05).
4. Conclusion
According to the study results, nurses' perception of the ethical atmosphere has no significant relationship with their ethical reasoning and moral courage. Having a positive moral atmosphere in the treatment environment and the nursing profession is necessary and inevitable. It promotes moral values, such as moral courage and moral reasoning in the clinical setting. Although having a moral attitude towards issues and having moral courage have a significant impact on creating a positive moral atmosphere, the ability to make decisions based on moral reasoning is also essential.
The present study showed that nurses' understanding of the moral climate is favorable. Research shows that the organization's climate significantly impacts the emergence and spread of ethical behaviors. Managers of organizations should be role models and supporters for employees in ethics and professionalism so that the staff can make decisions without fear and worry according to ethical values. The nurse, the patient, and the clinical setting benefit from that ethical practice. Altman acknowledges that a lack of moral courage is common in the present age. We must ultimately increase moral courage in nurses by increasing their courage and adherence to ethical principles. There is a significant relationship between demographic characteristics and moral reasoning and courage. In general, increasing work experience is expected to increase the ability of nurses to face ethical challenges and thus increase their moral reasoning and courage. Still, there may be other factors, such as organizational interests, differences in management, and the hospital's hospitality, that have taken from them the necessary ground to upgrade these capabilities. One of the limitations of this study is the small sample size, which can affect the results. It also affects the generalizability of the results. Another limitation of the present study is using the available sampling method.

Ethical Considerations
Compliance with ethical guidelines

This study was approved by the Ethics Committee of Yazd University of Medical Sciences (code: IR.SSU.REC.1398.050).

Funding
The Vice-Chancellor for Research and Technology of Shahid Sadoughi University of Medical Sciences of Yazd has financially supported this research (Research project number: 6183).

Authors' contributions
Conceptualization: Seyedeh Elham Fazloujoo, Khadijeh Nasiriani, Najmeh Zamani; Research: Seyedeh Elham Fazloujoo, Najmeh Zamani, Somayeh Azimpour; Editing and finalizing: Seyedeh Elham Fazloujoo, Khadijeh Nasiriani, Najmeh Zamani.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
We want to thank the Vice-Chancellor for Research and Technology of Yazd Shahid Sadoughi University of Medical Sciences for their support.


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Type of Study: Research | Subject: nursing
Received: 2021/07/23 | Accepted: 2021/11/11 | Published: 2022/01/1

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