The association between perceived hospital ethical climate and self-evaluated care quality for COVID-19 patients: the mediating role of ethical sensitivity among Chinese anti-pandemic nurses

Wenjing Jiang,Shujuan Sun,Huilin Zhang,Xianhong Li,Jia Jiang,Xing’E Zhao

doi:10.1186/s12910-021-00713-4

Wenjing Jiang, Shujuan Sun + Show 4 more

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https://doi.org/10.1186/s12910-021-00713-4

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Abstract

BackgroundThe COVID-19 pandemic called for a new ethical climate in the designated hospitals and imposed challenges on care quality for anti-pandemic nurses. Less was known about whether hospital ethical climate and nurses’ ethical sensitivity were associated with care quality. This study examined the association between the perceived hospital ethical climate and self-evaluated quality of care for COVID-19 patients among anti-pandemic nurses, and explored the mediating role of ethical sensitivity in this relationship.MethodsA cross-sectional study was conducted through an online survey. A total of 399 anti-pandemic nurses from ten designated hospitals in three provinces of China were recruited to fill out an online survey. Multiple linear regression analysis and a bootstrap test were used to examine the relationships between ethical climate, ethical sensitivity and care quality.ResultsNurses reported mean scores of 4.43 ± 0.577 (out of 5) for hospital ethical climate, 45.00 ± 7.085 (out of 54) for ethical sensitivity, and 5.35 ± 0.661 (out of 6) for self-evaluated care quality. After controlling for covariates, perceived hospital ethical climate was positively associated with self-evaluated care quality (direct effect = 0.710, 95% confidence interval [CI] 0.628, 0.792), and was partly mediated by ethical sensitivity (indirect effect = 0.078, 95% confidence interval [CI] 0.002, 0.145).ConclusionsChinese nurses who cared for COVID-19 patients perceived high levels of hospital ethical climate, ethical sensitivity, and self-evaluated care quality. Positive perceptions of hospital ethical climate were both directly associated with a higher level of self-evaluated care quality and indirectly associated, through the mediation effect of ethical sensitivity among anti-pandemic nurses.

Highlights

The COVID-19 pandemic called for a new ethical climate in the designated hospitals and imposed challenges on care quality for anti-pandemic nurses
Participant characteristics We collected a total of 439 questionnaires, of which 399 with completed information were used for analysis
This study targeted Chinese anti-pandemic nurses who directly cared for COVID-19 patients and provided essential insights into the association of hospital ethical climate with nurses’ self-reported care quality during the early stage of the COVID-19 pandemic

Summary

Introduction

The COVID-19 pandemic called for a new ethical climate in the designated hospitals and imposed challenges on care quality for anti-pandemic nurses. This study examined the association between the perceived hospital ethical climate and self-evaluated quality of care for COVID-19 patients among anti-pandemic nurses, and explored the mediating role of ethical sensitivity in this relationship. During the initial outbreak, frontline nurses (usually known as anti-pandemic nurses) faced an unprecedented workload with limited spaces to hold patients and without enough protective equipment. They were required to save lives and to protect their own [3, 4]. It was reported that a considerable proportion of anti-pandemic nurses experienced symptoms of depression, anxiety, insomnia, and distress [7]

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