Abstract
Rationale, aims and objectivesThe aims of this study are as follows: (a) to establish whether a relationship exists between the importance that healthcare professionals attach to ethics in care and their likelihood to report reprehensible conduct committed by colleagues, and (b) to assess whether this relationship is moderated by behavioural control targeted at preventing harm.MethodIn this cross‐sectional study, which was based on a convenience sample (n = 155) of nurse practitioners (NPs) and physician assistants (PAs) in the Netherlands, we measured ethics advocacy (EA) as a motivating factor (reflecting the importance that healthcare professionals attach to ethics and care) and “behavioral control targeted at preventing harm” (BCPH) as a facilitating factor. “Reporting reprehensible conduct” (RRC) was measured as a context‐specific indicator of whistleblowing intentions, consisting of two vignettes describing morally questionable behaviour committed by colleagues.ResultsThe propensity to report reprehensible conduct was a function of the interaction between EA and BCPH. The only group for which EA predicted RRC consisted of individuals with above‐average levels of perceived BCPH.ConclusionThe results suggest that the importance that healthcare professionals attach to ethical aspects in care is not sufficient to ensure that they will report reprehensible conduct. Such importance does not induce reporting behaviour unless the professionals also perceive themselves as having a high level of BCPH. We suggest that these insights could be helpful in training healthcare providers to cope with ethical dilemmas that they are likely to encounter in their work.
Highlights
In recent decades, healthcare professionals have increasingly been encountering moral dilemmas in their daily work
In summary, our research has two aims: 1) to establish whether a relationship exists between attitudes toward ethics advocacy (EA, variable X) and the likelihood of reporting reprehensible conduct committed by colleagues (RRC, variable Y), and 2) to assess whether behavioural control targeted at preventing harm (BCPH, variable M) interacts with the relationship between X and Y
We measured behavioural control according to the following five items, which tapped the extent to which health practitioners were confident in their skills and alertness to prevent harm to the patient: (a) “I always feel responsible for proper patient care, even if the resources are insufficient,” (b) “My skill in assessing the needs of the patient always helps me in my work,” (c) “I can always properly assess whether and when a patient should be told the truth,” (d) “I can sense when a patient is not receiving proper care,” and (e) “In patient care, I am always aware of the balance between performing the task well and the risk of harm to the patient.”
Summary
Healthcare professionals have increasingly been encountering moral dilemmas in their daily work. It is more difficult to reach substantiated moral judgements in contexts involving conflicting interests between professionals and patients.[6] The influence of the aforementioned stressors on the ethical decision-making process is known to cause “moral distress”: a psychological disequilibrium occurring when the proper course of action is known, but circumstances prevent taking such action.[7] The increasing transformation of healthcare delivery into a moral enterprise is making it more likely that the numerous dilemmas arising in the daily work of healthcare providers will complicate the process of making ethical decisions, evoking a succession of moments of moral distress. We predict that the likelihood of healthcare professionals to report reprehensible conduct is determined by a combination of the extent to which they attach importance to ethics in care and their level of perceived behavioural control.
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