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

Discussion In-service training on ethics was associated with the positive ethical climate. Hospital should enhance ethical education. Conclusion Ethical climate related to the nurses’ personal characteristics and continuing education. We propose that organizational support for ethical education may be effective in raising the ethi- cal climate of the workplace. Introduction In recent years, there has been a growing interest in the importance of creating a healthy and ethical work environment in clinical practice [1]. The ethical climate is considered an essential component of the organizational climate and is defined as shared perceptions of what is ethi- cally correct behavior and ways to handle ethical issues [2]. Ethical climate refers to an envi- ronment in the organization that an individual perceives to influence and set the standard for employee behavior [3]. To measure ethical climate objectively, researchers have developed various theories and measurements. In this study, the scale developed by Olson [4], the Hospital Ethical Climate Survey (HECS), was used to measure the ethical climate of hospitals. Using instruments, it has been argued that the ethical climate may influence nurses’ well-being in the workplace and the quality of patient care provision, making it a significant factor in the nursing environment [5]. Various studies show that an ethical climate may be associated with or affect moral distress [6– 9], job satisfaction [10, 11] turnover intentions and medical error experience [12], satisfaction

with the quality of care and collaboration [7], ethical leadership [11], and moral sensitivity [13, 14]. Additionally, research is being conducted to clarify the relationship between ethical cli- mate and demographic factors such as age, gender, nurses’ education degree, material status, years of experience, employment status, job position, education degree, training related to eth- ics, type of work (daytime or shift), weekly work time, the average number of patients cared for, working conditions, etc. [11, 12, 15–18]. The ethical climate is the pervasive moral atmosphere of a social system, characterized by the shared perceptions of right and wrong, as well as common assumptions about how moral concerns should be addressed [19]. Therefore, investigating the ethical climate of hospitals contributes to enhancing the work environment and quality of care in the context of nursing [18]. The ethical climate is the shared perception formed in the nurses’ workplace. According to our previous study, nurses’ perceptions of bed alarm system and physical restraint were related to the hospital they belong to, years of experience and education [20]. Ethics education is a method for preventing or addressing moral distress [21] and has a positive influence on moral confidence, moral action [22], ethical decision making and ethical behavior [5]. The nurses and social workers with ethics education use ethics resources more often [22]. In this way, ethics education is an important factor for nurses’ moral perception and action. There-

fore, we created a hypothesis that ethical education might change the perception of the ethical climate for nurses. According to previous studies, there is no relationship between nurses’ education degree and ethical climate score [11, 12, 15, 16, 23, 24]. However, continuing education includes post- PLOS ONE Ethical climate and ethics education PLOS ONE | https://doi.org/10.1371/journal.pone.0269034 July 21, 2022 2 / 15