الفهرس 
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Abstract
Ethical work climate refers to the organizational culture and values that support ethical behavior and decision-making in the workplace. Nurses’ perception of moral distress refers to the experience of feeling unable to act in accordance with their moral beliefs due to institutional constraints, while compassion competencies refer to the ability to provide compassionate care to patients. Ethical work climate is crucial for promoting nurses’ moral well-being and enhancing their ability to provide compassionate care to patients. Organizations that prioritize ethical values and behaviors are likely to have more satisfied and effective nursing staff that can provide high-quality care to their patients.
Aim of the study:
This study aim was to identify the relationship between ethical work climate and nurses’ perception of moral distress and compassion competences.
Setting:
This research was conducted at Alexandria Main University Hospital in all critical care units (N=8), as well as all intensive care units (N=15). Alexandria Main University Hospital affiliated to Alexandria University is the major governmental hospital in Alexandria and it employs a large number of nurses with different qualifications and multispecialty of medical services.
Subject:
The study subjects will include all nurses working in the previously mentioned setting, with a working experience of least one year and who have direct contact with patients. (N=191) they are categorized as follows: the critical care units (N = 70), the intensive care units (N = 121).
Tools of the study:
Three tools were applied to gathering data of this study:
Tool (1): Revised Ethical Climate Questionnaire (RECQ)
It was developed byVictor and Cullen (1988), and revised by Cullen, Victor, and Bronson (1993). It was adopted by the researcher to assess level of nurses’ perception regarding ethical work climate. This tool consists of 12 items classified into three dimensions namely: Egoism, Benevolence, and Principled with four items under each dimensio(Putranta & Kingshott, 2011). The response was measured on 7-point Likert scale ranging from (1) strongly disagree to (7) strongly agree. The overall score level ranged from 12 to 84. The score ranging from (12 < 36) indicates lower perception of ethical work climate, score ranging from (36 < 60) indicated a moderate ethical work climate perception, and score ranging from (60 ≤ 84) indicates higher perception of ethical work climate.
Tool (2): Moral Distress Scale-Revised (MDS-R):
Corley have developed this tool in 1995, then it was revised byHamric et al. (2012). The researcher adopted to assess moral distress as perceived by nurses. This tool consists of 21 items measuring the frequency and intensity of moral distress. Scoring of the MDS-R is achieved by using a 5-point Likert scale. Frequency of moral distress ranged from 0 (never) to 4 (very frequently), and intensity ranged from 0 (none) to 4 (great extent). The Item scores for moral distress intensity and moral distress frequency are multiplied and summed for each of the 21-items creating a new variable for each item, the frequency x intensity (fxi) ranged from 0 to 16. Overall score level ranged from 0 to 336. The score ranging from (0 < 112) indicates low level of moral distress, score ranging from (112 < 224) indicates moderate level of moral distress, and score ranging from (224 ≤ 336) indicates higher level of moral distress.
Tool (3):Compassion Competence Scale (CCS):
It was developed by Lee and Seomun (A) (2016). It was adopted by the researcher to investigate nurses’ compassion competences. It consists of 17 items related to the following three dimensions: communication (eight items), sensitivity (five items) and insight (4 items). Responses were measured on 5-point Likert scale ranged from (1) strongly disagree to (5) strongly agree. The overall score level ranging from 17 to 85. The score ranges from (17 < 39) indicates low level of compassion competence, score ranges from (40 < 63) indicates moderate level of compassion competence, and score ranges from (63 ≤ 85) indicates high level of compassion competence.
In addition, nurses’ socio-demographic data tool was developed by the researcher and includes: personal information related to gender, age, marital status and professional information related to type of unit, educational qualifications, employment status, years of practicing as a nurse and years of experience in the unit.
Method:
Approval to conduct the study was obtained from the Research Ethics Committee, Faculty of Nursing, Alexandria University.
An official permission was obtained from the dean of the Faculty of Nursing, Alexandria University, to the hospital authority to get an agreement to conduct the study.
A written approval was obtained from hospital administrative authority to conduct the study after providing explanation of the aim of the study.
Study tools were translated into Arabic, and then back to back translation was done.
The research tools were tested for both their validity: face and content by five experts in the field of the research and accordingly the necessary modificationsweredone.
The study was tested for reliability of tools I, II (frequency and intensity), III measured by Cronbach’s Alpha test. The reliability values were tool I = (0.850), tool II (frequency and intensity) value = (0.841, 0.871), tool III= (0.901).
A Pilot study was carried out on 10% of nurses (n=20) from Alexandria Main University Hospital to check and ensure clarity, applicability, and feasibility of the study tools, and identify obstacles and problems that may be encountering during data collection.Based upon feedback from the pilot study, there was no change or modification required,the pilot participants were included in the study.
8. Data collection:
Studied nurses were approached by the researcher through self-reported questionnaires was hand delivered at the break time. The researcher clarified the aim of the study and instructions needed were provided before the distribution of the questionnaire.
The questionnaire was completed in the presence of the researcher to ensure objectivity of nurse’s response, avoid contamination of subjects’ opinion and check that all items were answered. The amount of time needed to fill the questionnaire was about 15-20 minutes for each subject.
Data collection took a period of two months from 10/5/2022 to 10/7/2022.
Ethical consideration:
Written informed consents were obtained from the study participants after the explanation of the aim of the study.
Anonymity of the study participants was assured.
Confidentiality of the data collected was maintained, and privacy was assured.
The participants were informed that they have the right to withdraw from the study without any penalties.
The main results of the present research were as follow:
- The levels of perception of ethical work climate of nurses were moderate level (65.71±10.54).
- The overall moral distress among nurses was moderate level (34.15 ± 18.34).
- The overall compassion competence of nurses was high level (80.78 ± 10.41).
- There was a high statistical negative correlation among the overall perceptions of ethical work climate and overall moral distress of nurses (r=-0.243*, p=0.001*). While, there was a weak statistical positively significant association between the overall perceptions of ethical work climate and overall compassion competences of nurses (r=0.232*, p=0.001*).
- There was a statistical negative correlation between the overall perceptions of ethical work climate and overall moral distress of nurses; when the ethical work climate increases by one unit, moral distress decreases 1.689 units.
- On the other hand, there was a statistical positive correlation between the overall perceptions of ethical work climate and overall compassion competences of nurses; when the ethical work climate increases by one unit; it leads to increase the compassion competences to 0.231 units.
- There was significant difference between overall of ethical work climate and studied nurses’ demographic characteristics regarding to age, level of education, years of experience in nursing and years of experience in current working unit (p=<0.001*, <0.001*, 0.006*, 0.030*)respectively.
- There was significant difference between overall of moral distress and studied nurses’ demographic characteristics including age, working unit, level of education, years of experience in nursing and years of experience in current working unit (p=0.020*, 0.043*, 0.002*, < 0.001*, <0.001*) respectively.
- There was significant difference between overall of compassion competences and studied nurses’ demographic characteristics according to age, educational level, years of nursing experience and especially in the current working unit (p=0.023*, 0.020*, 0.037*, 0.002*)respectively.
Conclusion
In the light of the study results, it can be concluded that, the highest percentage of studied nurses were perceived moderate level of EWC and slightly moderate level of moral distress (MD). While, the highest percentage of studied nurses were perceived high level of compassion competences (CC). Regarding to relationship between ethical work climate (EWC) and MD there was a negative statistical significant correlation between nurses’ perception of EWC and MD. While, there was a positive significant correlation between nurses’ perception EWC and CC at Alexandria Main University Hospital.
Recommendations
Based on the study findings, the following recommendations can be suggested to improve the EWC of nursing organization that lead to increases nurses’ satisfaction, CC and decrease MD.
The following recommendations directed to:
A: Hospital organization and administrators:
- Apply the concept of Shared governance by allowing the participation of nursing director in sound decision making related to nurses’ rights, responsibilities and justice to enhance EWC.
- Develop strategies to improve of EWC and reduce MD through planning and implementation of workshops related to ethical issues and policies to solve ethical problem in the workplace.
B: For nurse managers:
- Conduct a training program to improve nurses’ sense of responsibility toward effectively and efficiently use of available resources to control organization’s cost for improving EWC.
- Assure equality principles in nursing staff time schedule of distribution of nursing care assignment.
C: For nursing staff:
- Improve communication skills (verbal and nonverbal) by attending relevant workshops that enhance compassionate patient care.
- Improve nurses’ knowledge and awareness of caring behavior and compassion competence through attendance of workshops and training programs.
Further study:
- Investigate the relationship between compassion competences and missed nursing care.
- Assess the effect of using coping mechanism strategies on nurses regarding how to deal with moral distress.
- Assess the effect of cultures of nurses on compassionate care for patients.