Nurse managers' experience with ethical issues in six government hospitals in Malaysia: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Nurse managers have the burden of experiencing frequent ethical issues related to both their managerial and nursing care duties, according to previous international studies. However, no such study was published in Malaysia. The purpose of this study was to explore nurse managers' experience with ethical issues in six government hospitals in Malaysia including learning about the way they dealt with the issues.</p> <p>Methods</p> <p>A cross-sectional study was conducted in August-September, 2010 involving 417 (69.2%) of total 603 nurse managers in the six Malaysian government hospitals. Data were collected using three-part self-administered questionnaire. Part I was regarding participants' demographics. Part II was about the frequency and areas of management where ethical issues were experienced, and scoring of the importance of 11 pre-identified ethical issues. Part III asked how they dealt with ethical issues in general; ways to deal with the 11 pre-identified ethical issues, and perceived stress level. Data were analyzed using descriptive statistics, cross-tabulations and Pearson's Chi-square.</p> <p>Results</p> <p>A total of 397 (95.2%) participants experienced ethical issues and 47.2% experienced them on weekly to daily basis. Experiencing ethical issues were not associated with areas of practice. Top area of management where ethical issues were encountered was "staff management", but "patient care" related ethical issues were rated as most important. Majority would "discuss with other nurses" in dealing generally with the issues. For pre-identified ethical issues regarding "patient care", "discuss with doctors" was preferred. Only 18.1% referred issues to "ethics committees" and 53.0% to the code of ethics.</p> <p>Conclusions</p> <p>Nurse managers, regardless of their areas of practice, frequently experienced ethical issues. For dealing with these, team-approach needs to be emphasized. Proper understanding of the code of ethics is needed to provide basis for reasoning.</p

The ethical climate and its relation to individualised care

The achievement of the main goals of the nursing profession, including the provision of quality and individualised nursing care to patients, often requires improvements in the working environment of nurses, while there are various research evidences to support such a need. However, it is additionally recognised in the scientific community that the ethical climate of an organisation is actually an important component of the overall working environment that is related to employees’ shared perceptions of what is ethically correct behaviour and how ethical issues should be handled in organisations. Moreover, both the nurses’ practice environment and the ethical climate that exist in healthcare settings specifically, as it is perceived by nurses themselves, had been linked in some studies to various important professional variables and patient outcomes including individualised nursing care. Having this in mind, the aim of this chapter is to discuss the literature regarding the ethical climate as it is perceived by nurses themselves with a focus on the association between ethical climate and individualised nursing care. In this light the chapter attempts to demonstrate the existing body of relevant knowledge and the possible knowledge deficits that need exploration with further research studies