Document Type : Original Article

Authors

1 Professor of Biostatistics, Department of Epidemiology and Biostatistics, School of Public Health, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

2 Department of Health Community, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran

3 Department of Nursing, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Abstract

BACKGROUND: The ethical guidelines and ethical atmosphere of the hospital affect the quality
of nursing care. Improving the health of patients in most cases depends on the observance of
ethical points and ethical behaviors by nurses. The aim of this study was to determine the effect of
hospital ethics and ethical training guidelines on improving the quality of nursing care and nurses’
professional ethics.
MATERIALS AND METHODS: This is a descriptive‑analytical study. This study was performed by
multi‑stage relative cluster sampling on 260 qualified nurses in 2014. Data were collected using the
Hospital Ethical Climate Questionnaire and the Judgments about Nursing Decisions Questionnaire
and analyzed using SPSS software version 19.
RESULTS: The results showed that nurses’ perceptions of the ethical climate of hospitals were
relatively positive. The ethical behavior of nurses was moderate and good. Nurses’ perception of the
ethical climate scores was not related to the ideal ethical behavior of nurses (r = 0.11, P = 0.86).The
ethical climate perceptions of nurses were related to real workplace ethical behavior score (r = 0.188,
P = 0.002). The results also showed that ethical guidelines can improve the quality of nursing care.
CONCLUSION: Considering the results of this study, it seems that holding nursing ethics training
programs can be a big step toward promoting the professional behavior of nurses and the observance
of professional ethics by nurses.

Keywords

1. Borhani F, Hoseini SH, Abaszadeh A, Abbasi M, Fazljoo E. Nurses’
perceptions of Ethical climate governing the teaching hospital
affiliated with the University of Medical Sciences Shahid Sadughi
Yazd. Med Ethics 2014;8:41‑65.
2. Asadi L, Beigi M, Valiani M, Mardani F. Evidence‑based draft
guideline for prevention of midwifery malpractices based on
referred cases to the forensic medicine commission and the
medical council from 2006‑2011. Iran J Nurs Midwifery Res
2017;22:313‑8.
3. Safari Y, Khatony A, Khodamoradi E, Rezaei M. The role of
hidden curriculum in the formation of professional ethics in
Iranian medical students: A qualitative study. J Educ Health
Promot 2020;9:180.
4. Alipour F, Shahvari Z, Asghari F, Samadi S, Amini H. Educational
system defects and observing professional behavior: A qualitative
study. J Educ Health Promot 2019;8:162.
5. Borhani F, Jalali T, Abbaszadeh A, Haghdoost A. Nurses’
perception of ethical climate and organizational commitment.
Nurs Ethics 2014;21:278‑88.
6. Sims RR, Brinkmann J. Business ethics curriculum design:
Suggestions and illustrations. Teach Bus Ethics 2003;7:69‑86.
7. Pagliaro S, Lo Presti A, Barattucci M, Giannella VA, Barreto M. On
the effects of ethical climate(s) on employees’ behavior: A social
identity Approach. Front Psychol 2018;9:960.
8. Wang YD, Hsieh HH. Toward a better understanding of the link
between ethical climate and job satisfaction: A multilevel analysis.
J Bus Ethics 2012;105:535‑45.
9. Dinc MS, Huric A. The impact of ethical climate types on nurses’
behaviors in Bosnia and Herzegovina. Nurs Ethics 2017;24:922‑35.
10. Arnaud A, Schminke M. The ethical climate and context of
organizations: Acomprehensive model. Organ Sci 2012;23:1767‑80.
11. Nikkhah Farkhani Z, Rahimnia F, Kazemi M, Shirazi A. Modeling
the ethical behavior of nurses using the theory of virtue ethics.
IJME 2015;7:29‑48.
12. Ashoori J. The relationship between ethical reasoning, ethical
behavior and nurses’ health with their ethical metacognition.
Med Ethics 2016;9:55‑76.
13. Asadi L, Beigi M, Valiani M. Maternal and neonatal complications
leading to midwifery errors in referred cases to the Iranian legal
medicine organization and medical council of forensic medicine
from 2006‑2011 in Isfahan, Iran. Womens Health Bull 2018;5(3):1‑5
14. Hem MH, Halvorsen K, Nortvedt P. Altruism and mature care:
Some rival moral considerations in care ethics. Nurs Ethics
2014;21:794‑802.
15. Borhani F, Keshtgar M, Abbaszadeh A. Moral self‑concept and
moral sensitivity in Iranian nurses. J Med Ethics Hist Med 2015;8:4.
16. Zhang Y, Zhou F, Mao J. Ethical leadership and follower moral
actions: Investigating an emotional linkage. Front Psychol
2018;9:1881.
17. Esmaelzadeh F, Abbaszadeh A, Borhani F, Peyrovi H. Ethical
sensitivity in nursing ethical leadership: A content analysis of
Iranian nurses experiences. Open Nurs J 2017;11:1‑3.
18. Numminen O, Leino‑Kilpi H, Isoaho H, Meretoja R. Ethical
climate and nurse competence‑newly graduated nurses’
perceptions. Nurs Ethics 2015;22:845‑59.
19. Olson LL. Hospital nurses’ perceptions of the ethical climate of
their work setting. Image J Nurs Sch 1998;30:345‑9.
20. Ketefian S. Moral reasoning and moral behavior among selected
groups of practicing nurses. Nurs Res 1981;30:171‑6.
21. Mobasher M, Nkhaee N, Garoosi S. Assessing the ethical climate
of Kerman teaching hospitals. Iran J Med Ethics Hist Med
2008;1:45‑52.
22. EtemadiR, Jafari N. Study the responsibility of nurses (professional
ethics and human), the recovery rate of patients. Mil Caring Sci
2014;1:57‑62.
23. Jalali T, Kalantari S, Afshar MH, Joubary LM. The nurse’s
perception from the hospital ethical climate. Jentashapir J Health
Res 2013;4:65‑73.
24. Khazani S, Shayestehfard M, Saeed‑al‑Zakererin M, Cheraghian B.
Nurses’ perception of actual and ideal organizational ethical
climate in hospitals of Ahwaz Jondishapour University of Medical
Sciences in 1390‑91. Iran J Med Ethics Hist Med 2013;6:99‑110.
25. Corley MC, Minick P, Elswick RK, Jacobs M. Nurse moral distress
and ethical work environment. Nurs Ethics 2005;12:381‑90.
26. Ranjbar H, Joolaee S, Vedadhir A, Abbaszadeh A, Bernstein C.
Becoming a nurse as a moral journey: A constructivist grounded
theory. Nurs Ethics 2017;24:583‑97.
27. Deshpande SP, Joseph J. Impact of emotional intelligence, ethical
climate, and behavior of peers on ethical behavior of nurses. J Bus
Ethics 2009;85:403.
28. Rajiah K, Venaktaraman R. The effect of demographic and social
factors on the decision‑making of community pharmacists in
ethical dilemmas. J Res Pharm Pract 2019;8:174‑7.
29. Karimi M, Rajaeipour S, Huweida R. Studying the relationship
between organizational climate and ethical behavior among
employees in Isfahan universities and Isfahan Medical University.
Train Leadersh Manage Q 2010;4:83‑102.30. Pachter LM, Coll CG. Racism and child health: a review of the
literature and future directions. J Dev Behav Pediatr. 2009 Jun;
30 (3):255‑63. doi: 10.1097/DBP. 0b013e3181a7ed5a. PMID:
19525720; PMCID: PMC2794434.
31. Joolaee S, Jalili H, Rafiee F, Haggani H. The relationship between
nurses’ perception of moral distress and ethical environment in
Tehran University of Medical Sciences. Iran J Med Ethics Hist
Med 2011;4:56‑66.
32. Nakhae N, Mobasher M, Garusi S. Assessment of ethical
climate (organizational culture) hospitals in Kerman. Iran J Med
Ethics Hist Med 2007;1:45‑52.
33. Borhani F, Jalali T, Abbaszadeh A, Haghdoost AA, AmiresmailiM.
Nurses’ perception of ethical climate and job satisfaction. J Med
Ethics Hist Med 2012;5:6.
34. Pauly B, Varcoe C, Storch J, Newton L. Registered nurses’
perceptions of moral distress and ethical climate. Nurs Ethics
2009;16:561‑73.
35. Ulrich C, O’Donnell P, Taylor C, Farrar A, Danis M, Grady C.
Ethical climate, ethics stress, and the job satisfaction of
nurses and social workers in the United States. Soc Sci Med
2007;65:1708‑19.
36. Saeedi R, Gholami M, Dinparvar SH, Kabirian M. Short
Communication: Transcutaneous Feeding: The EffecT of Massage
with Coconut Oil on Weight Gaining in preterm Newborns.
Iranian Red Crescent Medical Journal 2011;13:570-72.
37. Gholami M, Moallem SA Afshar M, Etemad L, Karimi G. Maternal
exposure to silymarin leads to phatological changes in mouse
foetuses. Pharmacologyonline. 2015;2;38‑43.