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

than those who had not (p = 0.023). The difference between J-HECS26 and demographic vari- ables of marital status, education degree, license, and position were not statistically significant. Multiple regression analysis was used to assess the association between demographic vari- ables and J-HECS26 (Table 4). The mean J-HECS26 score showed significant increase in man- ager nurses (p = 0.033) and nurses in the psychiatry unit (p = 0.007) obstetrics unit (p = 0.014), and emergency department (p = 0.031) and showed significant decrease in nurses with less experience (p = 0.002), male nurses (p = 0.020), and nurses in the operating room (p = 0.004). Continuing education Further multiple-regression analysis was conducted to assess the association between continu- ing education and J-HECS26 scores (Table 4). In Model 2, the mean J-HECS26 score showed a significant increase in nurses who had attended in-service training at the workplace (p = 0.031). In Model 3, the mean J-HECS26 score significantly decreased in nurses who had attended workshops/ academic conferences (p = 0.028). Table 5 shows the multivariate-adjusted mean of the J-HECS26 score. The nurses who had attended in-service training at the workplace scored 2.63 points, which was significantly higher than those who had not attended any (p = 0.038, 95% CI: 0.15, 5.11). Nurses who had attended workshops/ academic conferences scored 3.30 points lower than those who did not (p = 0.033, 95% CI: - 6.33, - 0.28). Discussion The purpose of this study was to ascertain the factors that might affect the ethical climate by

using J-HECS26, which we first translated into Japanese before distributing it among the par- ticipants. We focused on the demographic data and education since the detailed influence of education on HECS has not been fully reported so far. Nurses’ level of ethical climate The present study indicated that the mean score of J-HECS26 and sub-scales were 94.8. The mean score of J-HECS26 in this study was more than that in Khalesi [34] (71.5) and Shafipour, Yaghobian, Shafipour, and Heidari [35] (91.8), whereas it was less than that in Bansal [16] (116.7) and Tehranineshat [36] (100.1). All these studies were conducted in teaching hospitals, as was done in our study. It was found that nurses in this study perceived their ethical climate as relatively desirable. Demographic characteristics There was a significant relationship between nurses’ demographic characteristics and their perception of ethical climate. Younger nurses and those with less experience have a more Table 2. J-HECS26 score (n = 605). Mean SD Min Max Total score of J-HECS26 94.8 14.8 47 130 Peers (4 items) 16.3 2.5 8 20 Patients (4 items) 15.2 2.0 8 20 Managers (6 items) 22.5 5.9 6 30 Hospital (6 items) 21.0 3.6 10 30 Physicians (6 items) 19.8 4.2 6 30 https://doi.org/10.1371/journal.pone.0269034.t002 PLOS ONE Ethical climate and ethics education PLOS ONE | https://doi.org/10.1371/journal.pone.0269034 July 21, 2022 7 / 15