The relationship between hospital ethical climate and continuing education in nursing ethics

Strength and limitations The strength of this study is that it is the first to use J-HECS26 (translated into Japanese), with all 26 items of the original HECS. Further, our study clearly demonstrated a relationship between demographic characteristics and ethics education by using multiple regression analy- sis. However, our study did not clarify the details of ethics education (i.e., timing, frequency, and content). Moreover, since educational support differs depending on the hospital, a selec- tion bias may have occurred. Therefore, future studies must analyze hospitals of other sizes and that offer different services in order to clarify the details of education. Ethical climate has been reported to be related to various other factors such as ethical stress or job satisfaction. Thus, another limitation is that these factors were not measured in our questionnaire. Conclusion This study examined nurses’ perceptions of the ethical climate in Japanese teaching hospitals. Nurses’ perception of ethical climate varied based on individual characteristics such as years of experience, gender, job position, hospital, and specialty of the unit. We also demonstrated that in-service training, adjusted for the workplace, is effective in raising employee perception of the ethical climate. Lastly, off-the-job workshops/ academic conferences are not directly related to enhancing the ethical climate and, hence, should be implemented carefully. Supporting information S1 Dataset. (XLSX) Acknowledgments The authors are grateful to all the participants for their contribution to the study.

Author Contributions Conceptualization: Ayaka Okumoto, Chiharu Miyata. Data curation: Ayaka Okumoto, Satoko Yoneyama. Formal analysis: Ayaka Okumoto, Satoko Yoneyama. Funding acquisition: Ayaka Okumoto, Ayae Kinoshita. Investigation: Ayaka Okumoto, Ayae Kinoshita. Methodology: Ayaka Okumoto, Satoko Yoneyama, Ayae Kinoshita. Project administration: Ayaka Okumoto, Ayae Kinoshita. Resources: Ayaka Okumoto. Supervision: Satoko Yoneyama, Chiharu Miyata, Ayae Kinoshita. Writing – original draft: Ayaka Okumoto. Writing – review & editing: Ayaka Okumoto, Satoko Yoneyama, Chiharu Miyata, Ayae Kinoshita. PLOS ONE Ethical climate and ethics education PLOS ONE | https://doi.org/10.1371/journal.pone.0269034 July 21, 2022 12 / 15