Perception of ethical climate among nurses in the hospital setting
DOI:
https://doi.org/10.21527/2176-7114.2025.50.15595Keywords:
Nursing, Ethics, Hospitals, Occupational HealthAbstract
Understanding nurses’ perceptions of the ethical climate based on their experiences of moral distress in the face of ethical and moral conflicts encountered in the hospital setting. This is a qualitative, exploratory-descriptive study conducted with 20 nurses working in psychiatry, emergency care, surgical clinic, and obstetric center of a university hospital in southern Brazil. Data collection took place between August and October 2021 through semi-structured interviews. Discursive textual analysis was employed. Two categories emerged: the first, “The ethical climate in the hospital setting” addressed aspects related to weaknesses and conflicts in care, interpersonal relationships, and management based on hierarchical structures; the second, “Moral sensitivity fostering an ethical climate in nursing practice”, referred to patient rights advocacy, organizational policies and practices, and professional recognition and appreciation. Moral sensitivity and effective communication are key elements for a positive ethical climate, as they promote an appropriate care environment and contribute to the defense of patient rights.
References
1. Caram CS, Peter E, Ramos FR, Brito MJ. The process of moral distress development: A virtue ethics perspective. Nursing Ethics. 2022; 29(2):402-412. DOI: 10.1177/09697330211033408
2. Jameton A. Nursing practice: the ethical issues. Prentice-Hall: Englewood Cliffs; 1984.
3. Ramos FRS, Barlem ELD, Brito MJM, Vargas MA, Schneider DG, Brehmer LCF. Conceptual framework for the study of moral distress in nurses. Texto contexto - enferm. 2016;25(2):e4460015. DOI: 10.1590/0104-07072016004460015.
4. Villagran CA, Bernardi CMS, Lanes TC, Dalmilin GL. Relação entre aspectos do tra-balho, sofrimento moral e síndrome de burnout em enfermeiros: revisão integrativa. Internati-onal Journal of Development Research. 2021; 11(11): 51618-51623. DOI: 10.37118/ijdr.23230.11.2021
5. Hou Y, Timmins F, Zhou Q, Wang J. A cross-sectional exploration of emergency de-partment nurses' moral distress, ethical climate and nursing practice environment. Int Emerg Nurs. 2021; 55:100972. DOI: 10.1016/j.ienj.2021.100972
6. Olson LL. Hospital nurses' perceptions of the ethical climate of their work setting. Image J Nurs Sch [Internet]. 1998; 30(4):345-9. DOI: 10.1111/j.1547-5069.1998.tb01331.x
7. Atabay G, Çangarli BG, Penbek Ş. Impact of ethical climate on moral distress revisi-ted: multidimensional view. Nurs Ethics. 2015; 22(1):103-16. doi: 10.1177/0969733014542674
8. Asgari S, Shafipour V, Taraghi Z, Yazdani-Charati J. Relationship between moral dis-tress and ethical climate with job satisfaction in nurses. Nurs Ethics. 2019; 26(2):346-356. DOI: 10.1177/0969733017712083
9. Bayat M, Shahriari M, Keshvari M. The relationship between moral distress in nurses and ethical climate in selected hospitals of the Iranian social security organization. J Med Ethics Hist Med. 2019; 12:8. DOI: 10.18502/jmehm.v12i8.1339
10. Bernardi CMS, Villagran CA, Lanes TC, Schutz TC, Dalmolin GL. Tendências de te-ses e dissertações brasileiras sobre sofrimento moral em enfermagem. RSD. 2020; 9(10):e5239108950. DOI: 10.33448/rsd-v9i10.8950
11. Schutz, TC, Dalmolin, GL, Andolhe, R, Barlem, ELD, Magnago, TSBS, Lanes, TC. (2023). Associação entre clima ético e síndrome de burnout entre enfermeiros hospitalares. Revista Psicologia: Organizações e Trabalho, 2023; 23(3), 2608-2615. DOI: 10.5935/rpot/2023.3.24762
12. Villagran CA, Dalmolin GL, Barlem ELD, Greco PBT, Lanes TC, Andolhe R. Associa-tion between Moral Distress and Burnout Syndrome in university-hospital nurses. Rev. Latino-Am. Enfermagem. 2023; 31:e3747. DOI: 10.1590/1518-8345.6071.37472023;31:e374710.1590/1518-8345.6071.3747
13. Fontanella BJB, Ricas J, Turato ER. Amostragem por saturação em pesquisas qualitati-vas em saúde: contribuições teóricas. Cad Saúde Pública. 2008; 24(1):17–27. DOI: 10.1590/S0102-311X2008000100003
14. Ministério da Saúde (BR). Orientações para condução de pesquisas e atividade dos CEP durante a pandemia provocada pelo coronavírus SARS-COV-2 (COVID-19) [Internet]. 2020. Available form: https://www.fo.usp.br/wp-content/uploads/2020/07/Orienta%C3%A7%C3%B5es-condu%C3%A7%C3%A3o-de-pesquisas-e-atividades-CEP.pdf
15. Moraes R, Galiazzi MC. Análise Textual Discursiva. 3ª ed. Ijuí, RS (BR): Unijuí; 2016.
16. Lanes TC, de Lima Dalmolin G, da Silva AM, Ramos FRS, Olson LL. Cross-cultural adaptation of the hospital ethical climate survey to Brazil. J Nurs Meas [Internet]. 2022; 31(2):148-162. DOI: 10.1891/JNM-2021-0036
17. Biondi HS, Barlem ELD, Pinho EC de, Tavares DH, Kerber NPC, Tomaschewski-Barlem JG. Moral suffering in assistance to childbirth: situations present in the work of nurses of obstetric centers and maternities. Texto contexto - enferm. 2019; 28:e20180052. DOI: 10.1590/1980-265X-TCE-2018-0052
18. Silva SCD, Morais BX, Munhoz OL, Ongaro JD, Urbanetto JS, Magnago TSBS. Pati-ent safety culture, missed Nursing care and its reasons in Obstetrics. Rev Lat Am Enferma-gem. 202; 29:e3461. DOI: 10.1590/1518-8345.4855.3461
19. Hasanlo M, Azarmb A, Asadic P, Aminid K, Ebrahimie H, Jafarabadif MA. Analytical study of care quality and moral distress in clinical situations and patient car. Frontiers of Nur-sing. 2019. 6(4):327-34. DOI: 10.2478/FON-2019-0037
20. Ramos FRS, Brehmer LC de F, Dalmolin G de L, Silveira LR, Schneider DG, Vargas MA de O. Association between moral distress and supporting elements of moral deliberation in nurses . Rev Latino-Am Enfermagem. 2020. 28:e3332. DOI: 10.1590/1518-8345.3990.3332
21. Dias JS, Rocha LP, Carvalho DP de, Tomaschewski-Barlem JG, Barlem ELD, Dalmo-lin G de L. Construction and validation of a tool to assess nursing interpersonal relations. Rev Bras Enferm. 2019; 72(2):408–13. DOI: 10.1590/0034-7167-2018-0229
22. Vryonides S, Papastavrou E, Charalambous A, Andreou P, Eleftheriou C, Merkouris A. Ethical climate and missed nursing care in cancer care units. Nurs Ethics. 2018; 25(6):707-723. DOI: 10.1177/0969733016664979
23. Lucena PLC, Costa SFG, Batista JBV, Araújo ELM, Soares CCD, Rolim RMGC. Tes-temunhas de assédio moral, na enfermagem: identificando características desse fenômeno, sentimentos e estratégias de enfrentamento. Reme : Rev. Min. Enferm. 2019; 23: e-1164. DOI: 10.5935/1415-2762.20190012.
24. Yasin JCM, Barlem ELD, Barlem JGT, Silveira RS da, Dalmolin G de L, Andrade GB de. The ethical dimension of problems faced in general medicine: relationship with moral sen-sitivity. Rev Latino-Am Enfermagem. 2020; 28:e3309. DOI: 10.1590/1518-8345.4033.3309
25. Tomaschewski-Barlem JG, Lunardi VL, Barlem ELD, Silveira RS, Ramos AM, Santos JM. Ações dos enfermeiros no exercício da advocacia do paciente: revisão integrativa. Texto contexto - enferm. 2018; 27(2):e0730014. DOI: 10.1590/0104-070720180000730014
26. Carvalho LA, Thofehrn MB, Barlem ELD, Fernandes HN, Campos Borel MG. As relações interpessoais da equipe de enfermagem sob a perspectiva da teoria dos vínculos pro-fissionais. renome. 2021; 10(1):52-64. DOI: 10.46551/rnm23173092202100106
27. Avancini RC, Barlem ELD, Tomaschewski-Barlem JG, Amorim CB, Rocha LP, Paloski G do R. Barreiras e facilitadores para construção de um ambiente ético em um serviço de traumatologia. Esc Anna Nery. 2021; 25(4):e20210005. DOI: 10.1590/2177-9465-EAN-2021-0005
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Camila Milene Soares Bernardi, Ariel Siqueira Lemos, Camila Antunez Villagran, Taís Carpes Lanes, Valdecir Zavarese da Costa, Graziele de Lima Dalmolin
This work is licensed under a Creative Commons Attribution 4.0 International License.
By publishing in Revista Contexto & Saúde, authors agree to the following terms:
The works are licensed under the Creative Commons Atribuição 4.0 Internacional (CC BY 4.0) license, which allows:
Share — to copy and redistribute the material in any medium or format;
Adapt — to remix, transform, and build upon the material for any purpose, including commercial.
These permissions are irrevocable, provided that the following terms are respected:
Attribution — authors must be properly credited, with a link to the license and indication of any changes made.
No additional restrictions — no legal or technological measures may be applied that restrict the use permitted by the license.
Notes:
The license does not apply to elements in the public domain or covered by legal exceptions.
The license does not grant all rights necessary for specific uses (e.g., image rights, privacy, or moral rights).
The journal is not responsible for opinions expressed in the articles, which are the sole responsibility of the authors. The Editor, with the support of the Editorial Board, reserves the right to suggest or request modifications when necessary.
Only original scientific articles presenting research results of interest that have not been published or simultaneously submitted to another journal with the same objective will be accepted.
Mentions of trademarks or specific products are intended solely for identification purposes, without any promotional association by the authors or the journal.
License Agreement (for articles published from September 2025): Authors retain copyright over their article and grant Revista Contexto & Saúde the right of first publication.
