Missed nursing care as related to the types of ethical climate in public hospitals

Abstract

Missed nursing care is defined as "any aspect of required patient care that is omitted (either in part or in whole) or delayed", (Kalisch et al. 2009, p. 1509), it can occur at any stage of the nursing process and it is influenced by factors in the care environment such as the allocation of resources (material and labor), relationships and communication, that affect nurses’ internal processes (e.g. values, beliefs, collective team norms) and guide them in deciding which nursing activity should be completed, should be missed, or should be delayed (Kalisch et al. 2009). Ethical climate in hospitals reflects the collective behavior of health care employees, acts as a reference of behavior when nurses face ethical issues and has a great impact on their decision-making process and on the quality of patient care. Victor and Cullen (1987) defined ethical climate as “the shared perceptions of what is ethically correct behavior and how ethical issues should be handled in organizations’’. Five types appear frequently in healthcare organizations which are the Caring, the Instrumental, the Rules, the Law and Codes and the Independence. Research on the relationship of the types of ethical climate with missed nursing care is limited. Since the nurses' practice environment has been linked to missed nursing care and having in mind that the ethical climate is actually a dimension of the whole working environment, as well as, the results of a previous study (Vryonides et al. 2016) that had examined this relationship in cancer care units (only), the current study further explores this relationship.