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

rather controversial. Some studies reported that age, gender, years of experience, and degree of education (i.e., nursing diploma /associate /bachelor’s /master’s degree) had no significant impact on the HECS scores [16, 18, 37], whereas other studies showed that age [12, 15], gender [11, 24], job position [12], years of experience [11, 12, 13, 15] and education degree (bachelor’s /master’s /doctoral degree) did have a statistically significant effect on the HECS [17]. Concerning years of experience, inexperienced nurses were reported to perceive ethical cli- mate optimistically [13, 15], which is consistent with our results in this current study. Table 4. Results of multiple regression analysis with J-HECS26 (n = 604). Model 1† Model 2‡ Model 3§ Coefficient t p value Coefficient t p value Coefficient t p value Years of experience -0.150 -3.1 0.002� -0.151 -3.1 0.002� -0.132 -2.7 0.007� Gender -0.091 -2.3 0.020� -0.090 -2.3 0.022� -0.089 -2.3 0.022� Manager 0.105 2.1 0.033� 0.092 1.9 0.064 0.110 2.2 0.029� Midwife -0.073 -1.0 0.329 -0.076 -1.0 0.311 -0.072 -1.0 0.336 Advanced license nurse -0.042 -1.0 0.298 -0.040 -1.0 0.327 -0.030 -0.7 0.465 Hospital 1 -0.152 -2.4 0.017� -0.127 -2.0 0.049� -0.116 -1.8 0.073 Hospital 2 -0.060 -1.0 0.339 -0.055 -0.9 0.383 -0.036 -0.6 0.569 Surgery 0.067 0.5 0.617 0.080 0.6 0.549 0.080 0.6 0.548 Internal medicine 0.210 1.6 0.110 0.220 1.7 0.093 0.223 1.7 0.088 Mixed surgery and internal medicine 0.143 1.5 0.138 0.151 1.6 0.117 0.155 1.6 0.106

Psychiatry 0.156 2.7 0.007� 0.159 2.8 0.006� 0.158 2.8 0.006� Pediatric 0.066 1.1 0.284 0.060 1.0 0.331 0.063 1.0 0.303 Obstetrics 0.213 2.5 0.014� 0.214 2.5 0.013� 0.217 2.5 0.012� Emergency department 0.106 2.2 0.031� 0.109 2.2 0.026� 0.107 2.2 0.029� Operating room -0.170 -2.9 0.004� -0.162 -2.8 0.006� -0.160 -2.7 0.007� ICU/CCU -0.026 -0.3 0.734 -0.023 -0.3 0.761 -0.019 -0.3 0.795 SCU 0.000 0.0 0.996 0.005 0.1 0.913 0.006 0.1 0.906 NICU 0.022 0.3 0.762 0.029 0.4 0.681 0.031 0.4 0.661 In-service training in workplace on ethics 0.088 2.2 0.031� 0.089 2.2 0.028� Workshops/ Academic conferences on nursing ethics -0.092 -2.2 0.028� R2 0.156 0.164 0.171 Notes † Model1: Un-adjusted ‡ Model2: Adjusted for Model 1 covariates § Model3: Adjusted for Model 2 covariates. � p< 0.05 https://doi.org/10.1371/journal.pone.0269034.t004 Table 5. Difference of multivariate-adjusted mean values of J-HECS26 (n = 604). (Yes) (No) (Yes)- (No) Mean 95% CI Mean 95% CI Mean 95% CI p value In-service training in workplace on ethics 95.7 94.3 97.0 93.0 91.0 95.0 2.63 0.15 5.11 0.038� Workshops/ Academic conferences on nursing ethics 92.1 89.4 94.8 95.4 94.1 96.7 -3.30 -6.33 -0.28 0.033� Notes: Adjusted for year of experience (continues), gender, hospital (dummy variables), manager, unit (surgery, internal medicine, mixed surgery and internal medicine, psychiatry, pediatric, obstetric, emergency department, operation, ICU/CCU, SCU, NICU: dummy variables), license (midwife, advanced license nurse: dummy

variables); CI = confidence interval. � p< 0.05 https://doi.org/10.1371/journal.pone.0269034.t005 PLOS ONE Ethical climate and ethics education PLOS ONE | https://doi.org/10.1371/journal.pone.0269034 July 21, 2022 9 / 15