Clinical Ethics, Knowledge, Attitudes and Practices of Nurses: A Limited Study in Turkey

Öz

Objective: The aim of this cross-sectional study was to evaluate nurses' knowledge, attitudes and practices regarding clinical ethics. Methods: The study was conducted with 300 nurses working in inpatient treatment units of Kocaeli University Hospital in Turkey between January 2023 and April 2023. No sample selection was made. The survey evaluated knowledge (16 questions), attitudes (14 questions) and practices (14 questions) regarding clinical ethics. Data were analyzed using SPSS version 25.0 and the p˂0.05 was considered significant. Results: A total of 207 nurses participated in the study, a response rate of approximately 70%. The mean age of the participants was 33.81±7.23 years. The mean ethical knowledge score of the respondents was 9.87.2±2.45 (3-16), the attitude score was 8.87±1.62 (5-13), and the implementation score was 10.35±2.47 (3-14). Nurses' clinical ethics knowledge, attitude and practice scores was above average. Nurse managers who were satisfied with their profession had higher clinical ethics practice scores. Nurses who did not need to receive ethics-related counseling or were able to access ethical counseling had better ethical knowledge and practice scores. There was a moderate positive correlation between ethical knowledge and ethical practice (r=0.109 p<0.001). Conclusion: Respondents reported significant knowledge about clinical ethics, but they lacked knowledge of some issues. As the ethical knowledge of the participants increased, their ethical practice scores also increased. These findings highlight the importance of increasing the knowledge of nurses about clinical ethics through training programs which should result in improved ethical practice.

Anahtar Kelimeler

• Ethical problem
• Nurse
• Knowledge
• Practice
• Clinical Ethics

Kaynakça

1. Shrestha C, Shrestha A, Joshi J, Karki S, Acharya S, Joshi, S. Does teaching medical ethics ensure good knowledge, attitude, and reported practice? An ethical vignette-based cross-sectional survey among doctors in a tertiary teaching hospital in Nepal. BMC Med Ethics. 2021; 22(109):1-16 https://doi:10.1186/s12910-021-00676-6.
2. Hakko A, Madenoğlu Kıvanç M. Creating Ethical Behaviors in Nursing Management. Journal of Health and Nursing Management. 2018;5(3):227-232. doi:10.5222/SHYD.2018.227.
3. Ranasinghe AWIP, Fernando B, Sumathipala A, Gunathunga W. Medical ethics: knowledge, attitude and practice among doctors in three teaching hospitals in Sri Lanka. BMC Medical Ethics. 2020; 21(69):1-10. https://doi:10.1186/s12910-020-00511-4.
4. Khoury B, Akoury-Dirani L. Ethical codes in the Arab region: comparisons and differences. Ethics & Behavior. 2023; 33 (3): 193–204 doi:10.1080/10508422.2022.2152817.
5. Tafesse N, Samuel A, Abiyu Geta A et al. Clinical ethical practice and associated factors in healthcare facilities in Ethiopia:a cross‑sectional study. BMC Med Ethics. 2022; 23(6):1-12 doi: 10.1186/s12910-022-00800-0.
6. Bijani M, Ghodsbin F, Fard SJ, Shirazi F, Sharif F, Tehranineshat B. An evaluation of adherence to ethical codes among nurses and nursing students. J Med Ethics Hist Med. 2017; 10(6):1-8.
7. Hafez FE, Mohamed HA, Eltabey Sobeh D. Assessment of Nurses' Knowledge and Practice Regarding. Professional Ethics in Outpatient Clinics at Mansoura University Hospital. IOSR-JNHS. 2016;5(6):20-28. doi: 10.9790/1959-0506072028
8. Akın Korhan E, Ceylan B, Üstün Ç, Kırşan M. Ethical problems in the clinical setting from the perspective of nursing students. Ege J of Med. 2018;57(2):75-81.

9. Elçigil A, Bahar Z, Beşer A, et al. Ethical Dilemmas which are Faced by Nurses, Anatolian Journal of Nursing and Health Sciences. 2011;14(2):52-60.
10. Asare P, Ansah EW, Sambah F. Ethics in healthcare: Knowledge, attitude and practices of nurses in the Cape Coast Metropolis of Ghana. Plos One. 2022; 17(2):1-11 doi:10.1371/journal.pone.0263557.
11. Aliyu D, Taiwo Adeleke I, Oluwafemi Omoniyi S, Ayuba Samaila B, Adamu A, Yahaya Abubakar A. Knowledge, attitude and practice of nursing ethics and lawamong nurses at Federal Medical Centre, Bida. American Journal of Health Research. 2015; 3(1-1): 32-37. doi: 10.11648/j.ajhr.s.2015030101.15.
12. Hariharan S, Jonnalagadda R, Walrond E. Knowledge, attitudes and practice of healthcare ethics and law among doctors and nurses in Barbados. BMC Med Ethics. 2006;7(7):1-9 doi:10.1186/1472-6939-7-7.
13. Adhikari S, Paudel K, Aro AR, Adhikari T.B, Adhikari B, Mishra S.R. Knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses from a resource poor setting, Nepal. BMC Med Ethics. 2016; 17(68):1-8 doi 10.1186/s12910-016-0154-9.
14. Aitamaa E, Suhonen R, Puukka P, Leino-Kilpi H. Ethical problems in nursing management – a cross-sectional survey about solving problems. BMC Health Services Research. 2019; 19:417. doi:10.1186/s12913-019-4245-4.
15. Ozdemir S, Aydin Er R. The evaluation of ethics education in midwifery undergraduate programs in Turkey. J of Nursing and Midwifery Sciences. 2022; 9(1):66-72. Doi:10.4103/JNMS.JNMS_138_20.
16. Eren N. Nurses’ attitudes toward ethical issues in psychiatric inpatient settings. Nurs ethics. 2014; 21(3): 359–73. doi:10.1177/0969733013500161.
17. Tekleab AM, Lantos JD. Ethics knowledge, attitudes, and experiences of tertiary care pediatricians in Ethiopia. BMC Med Ethics. 2022; 23:76 doi:10.1186/s12910-022-00812-w.
18. Lim A, Kim S. Nurses’ ethical decision-making during end of life care in South Korea: a cross-sectional descriptive survey. BMC Med Ethics. 2021; 22(94):1-9. doi:10.1186/s12910-021-00665-9.
19. Hemberg J, Hemberg H. Ethical competence in a profession: Healthcare professionals' views. Nursing Open. 2020;7:1249–1259. doi:10.1002/nop2.501.